Content Warning: mentions of mental health issues, suicide, suicide attempts and sexual assault.
‘Girl, Interrupted’ was written originally as a memoir in 1993 by Susanna Kaysen, exploring her experience in a US mental institution during the 1960s. It was then adapted into a 2-hour film 6 years later, which has seen a hugely varied reception. 30 years after its original publication, it is important to explore both what the piece uncovers about women’s mental health, as well as what it stigmatises and ‘gets wrong’.
After a suicide attempt, 18-year-old Susanna Kaysen (played by Winona Ryder) ‘voluntarily’ admits herself into McLean Mental Hospital, where she forms many complex relationships with the other female patients on the ward: the most striking being with Lisa Rowe (played by Angeline Jolie). Throughout her stay, she battles with her (mis)diagnosis, being torn also between trying to ‘get better’, or staying in the hospital, as well as what it means to be a mentally ill woman.
The most striking theme running throughout both the book and the film is the equation of social nonconformity with insanity; we are initially met with an ‘unsociable’ Kaysen, who deviates from traditional expectations of a 1960’s woman, particularly one who is Caucasian and middle-class . She rocks a short pixie cut, proclaims she only has miniskirts, and does not speak or hold herself with a stereotypical mid-20th century ‘ladylike’ demeanour.
Kaysen’s (mis)diagnosis is Borderline Personality Disorder (BPD): she is described as having no clear plans for her future, a general pessimism and as being promiscuous. However, her suicide attempt is the focus of this verdict – an event she denies constantly. The modern, lax diagnosing of BPD has come under criticism recently, with some describing it as a condition that has evolved into a ‘catch-all term’ for professionals to use, replacing the once gendered, popular ‘hysteria’. Certainly, there is some crossover between the two. For example, they are both targeted towards women with unconventional, ‘unfeminine’ character traits and behaviours, and they both believe that there is an ‘innate’ underlying cause . For the BPD the cause is ‘disordered personality’ and for hysteria it is ‘hormones’ and ‘biology’. Just over a decade before Kaysen was admitted into the institution, hysteria remained listed as a medical disease in the western world (1952). Therefore, it is important to remember that, though understandings of mental health have not been fixed, these (mis)understandings have been very influential until recently and do continue to impact modern conceptualisations of mental health conditions and treatment.
As such, (mis)understandings of women’s mental health have transcended time, particularly with regard to women’s sexuality. Women with ‘unconventional’ sexual desires were seen as mentally unwell: those without children, without husbands, those who did not have ‘enough’ sex, those who had ‘too much’, and those who had sex with the ‘wrong’ people. By not conforming to the married, monogamous, maternal ideal, these women did not obey the strict gender role expected of them, which created a ‘need’ to label them as abnormal from a scientific, intellectual perspective.
Similarly, Kaysen’s behaviours are labelled as “high-risk”. For example, her affair with her English teacher, or kissing an ‘orderly’ (mental health worker) in the film. Her medical notes label her “partnerless” and “promiscuous”, something that remains an important theme until the end. As Kaysen reflects: “Many disorders, judging by the hospital population, were more commonly diagnosed in women. Take for example, “compulsive promiscuity”. How many girls do you think a seventeen-year-old boy would have to screw to earn the label “compulsively promiscuous”?”, highlighting the double standard that has been utilised for centuries in labelling women with mental health issues.
Though neither Kaysen nor the professionals who work with her explicitly describe traumas or past abuse (though in her notes, she is said at one point to “become very frightened at the thought that she had never had a satisfactory childhood”), it remains certainly true that women who have experienced abuse or trauma, often from men, also then experience severe, complex mental health issues, often exhibiting behaviours which cross over into so-called ‘personality disorders’.
Within this, there is also the underlying belief that women are in some ways irrational, over-emotional and thus innately disordered; these beliefs drive and have driven (mis)understandings about women’s mental health for centuries. Certainly, Kaysen’s scepticisms about BPD’s gendered nature prefigured our understandings almost 60 years earlier: in the UK, it is advised that personality disorders should not be diagnosed in those under 18 and yet they frequently are. Teenage girls, particularly those with complex trauma, are the overwhelming recipients of this label – they are 7 times more likely to be diagnosed with it than boys who show the same symptoms.
Speaking to her psychiatrist, Kaysen shows both a clear awareness and aversion to conformity and unjust social norms that surround every aspect of her life:
“Look, I’m not gonna burn my bra or drop acid or go march on Washington… I just don’t want to end up like my mother”
(Psychiatrist): “Women today have more choices than that”
“No they don’t”
It is in dialogues such as this we see Kaysen navigating through her (mis)diagnosis – she does not see herself as radically different than everyone else, yet she also does not want to experience the confines of the 1960’s American Dream, nuclear-family style motherhood which has been pinpointed by society as the goal she must strive towards. Even beyond the domestic sphere however, in the workplace, Kaysen is not at peace with the injustice around her – in the book, she writes:
“All typists were women, all supervisors were men. All supervisors were smoking, all typists were not”,
“I was the one person who had trouble with the rules. Everybody else accepted them. Was this a mark of my madness?…
Was I crazy or right?…
Sexism! It was pure sexism – isn’t that the answer? It’s true, it was sexism.”
Though the difference seems so small and irrelevant to everyone around her, Kaysen’s observation is telling of women’s wider social oppression: is her apparent “disobedience” to the system because of a “madness” or is she instead challenging the injustice around her?
It seems minute, irrelevant even and can be easily missed – even Kaysen herself does not comment on it in her memoir – yet as soon as she enters the male doctors’ office, he states “You have a pimple” and only a sentence later asks “Have a boyfriend?”. Comments on her appearance and her relationship status are indicative about where the professionals’ focus is. Her observations not only serve as a critique of the experience she underwent as a vulnerable 18 year old, but also of the wider field of mental health, particularly in the US, as more of a money-making enterprise, than a support system for aiding those who are struggling.
By the end of the book, Kaysen continues to battle with the (mis)diagnosis – “What would have been an appropriate level of intensity of my anger at feeling shut out of life?” she asks. At what point is the line drawn between rationality and insanity? We as readers ask ourselves the same question.
Taking issue with the ‘borderline’ in ‘Borderline Personality Disorder’, she asks: “borderline between what and what?”, questioning the meaning of not only her own diagnosis, but also of mental health diagnoses in general: who has the authority to dictate ‘normality’ and what is ‘socially acceptable’? There have undoubtedly been waves of progress since the 1960’s in terms of mental health research and treatment, yet it remains important to understand the gendered and biased origins of mental health conditions’ criterions and to re-evaluate the understanding of science as a field free from socio-cultural influences.
Towards the end of the book, on a visit to the Frick in New York, the painting “Girl Interrupted at Her Music” by Johannes Vermeer (the inspiration for the book’s title), captures Kaysen’s entire attention.
‘Girl Interrupted at Her Music’ by Dutch painter Johannes Vermeer painted between 1658-1659
Is it a representation of women’s efforts and achievements constantly being ‘interrupted’ or undermined by men’s assumed superior intelligence? Does the ‘Girl Interrupted’ acknowledge us? Is she turning to us for help? What can it tell us about the universality of women’s experiences? Is it merely showing how music and love often intertwine?
The interpretation is up to you but Kaysen certainly feels a relatability to the Girl. After being struck by its beauty once before, she articulates:
“This time I read the title of the painting: Girl Interrupted at Her Music.
Interrupted at her music: as my life had been, interrupted in the music of being seventeen, as her life had been, snatched and fixed on canvas: one moment made to stand still and to stand for all the other moments, whatever they would be or might have been. What life can recover from that?”
She continues: “The girl at her music sits in another sort of light, the fitful, overcast light of life, by which we see ourselves and others only imperfectly, and seldom”
Her famous contemplation at the start of the film that “Maybe I was just crazy, maybe it was the 60s, or maybe I was just a girl… interrupted” reveals to us a self-awareness and reflectiveness that can sometimes accompany mental illness. The Boston Globe stated the work is “an exquisite range of self-awareness between madness and insight” and this is undeniably seen throughout Kaysen’s relentless dissecting of her reality and diagnosis. It transcends into our expressions of mental health too however, particularly amongst women, within which there is another layer of observation subconsciously impacting expressions of mental illness: an internalised male gaze. It has been exemplified on Tumblr during the 2010s, with the aesthetic curation of the ‘sad girl’ and has been translated into the 2020s’ even more consumerist versions on TikTok, that essentially package what it means to experience ‘mad-womanhood’.
Furthermore, Washington Post Book World claims the piece is “an account of a disturbed girl’s unwilling passage into womanhood… and here is the girl, looking into our faces with urgent eyes”. Though I would certainly disagree that Kaysen is not merely a “disturbed girl” resisting change, we could apply a similar perspective to Vermeer’s ‘Girl Interrupted’, as a younger woman, perhaps in a courtship with an older man, she too could be navigating a very similar “unwilling passage into womanhood”, “looking into our faces with urgent eyes” as she clearly is: leaving the potential comforts of childhood, thrown abruptly into the unknown abyss of adulthood.
Throughout the film, Kaysen’s ‘humanity’ and connection to ‘normality’ is preserved: the taxi driver on the way to the hospital points out she looks “normal”, senior nurse Valerie immediately understands Kaysen is ‘different’, not ill in the same way the other girls on the ward are and Lisa states that Susanna’s BPD symptoms are not unique, but rather “that’s everybody(‘s)” experience in life. This idea of mentally ill women being the same as ordinary women, but simply “amplified”, or the psychiatrists’ assertion that plenty of ordinary folk also go to mental institutions, “even writers like you”, upholds the progressive idea that for mentally ill people, their condition is merely a part of them, rather than their identity.
Though this is incredibly important in promoting the understanding that women with mental illness are human beings and women first and foremost, the distinction between Susanna and Lisa can be seen as having a stigmatising influence. Susanna progresses to become the socially acceptable mentally ill woman (able to reintegrate back into society), pitted against the socially unacceptable mentally ill woman, embodied by Lisa’s violent sociopathy. In this way, the film also promotes long-standing stereotypes of there being a “correct” way of having mental illness, that those who experience it ‘incorrectly’ are somehow ‘deserving’ of incarceration in institutions, under relentless surveillance, endless unexplained medication that leaves them catatonic, traumatising electrocution therapy and physical mishandling from orderlies. Lisa’s construction as the “unfeminine, immoral” other, entirely contrasts Susanna’s gradual resistance and turning away from her friend, becoming the more acceptable version of a mentally ill woman, despite being similarly “unfeminine” at some points in her journey.
Yet, as scholar Vera Chouinard argues, it is hardly black and white, instead there exists a dual influence: the book and film simultaneously take care to emphasise “the fundamental humanity of women with mental illness”, by reinstating ideas of their “relative normality and ordinariness”. The apparent fluidity between ‘monstrosity’ and ‘rationality’ helps to promote the understanding that mental illnesses are not fixed and innate, but rather that there is a potential for change, a potential to get better and a potential to live a fulfilling life despite and with mental illness. With these interpretations, you can argue that ‘Girl, Interrupted’ uncovers as much as it stigmatises; Kaysen’s memoir was not written with the intent of becoming a culturally important film and therefore her experiences should not form our whole understanding of the ‘mad woman’ experience. Rather, they should be understood as the expression of an individual woman’s navigation of mental illness.