Susana Kaysen, a 17 year old teenager voluntarily checks herself in at Claymoore after a confrontation with a psychiatrist. Claymoore is a psychiatric facility for the affluent in the 1960’s. She initially took fifty aspirin with a bottle of vodka for a headache and denies about killing herself. As a result, her parents ask a psychiatrist friend to see Susana and to take her to Claymoore. During her two year stay at Claymoore, she meets other patients whom she developed relationships with. She learns about the nature of mental illness, the cruelty and compassion of other people and the obstacles that women face in society. After a few months, Susana finally starts talking to her psychiatrist and gets a diagnosis of borderline personality disorder.
Borderline personality disorder is a pervasive pattern of instability in interpersonal relationships, self-image and emotions. It occurs mostly in early adulthood and is more prevalent in females. People with this disorder often exhibit impulsive behaviors and shows majority of these symptoms in order to be diagnosed:
1) Frantic efforts to avoid real or imagined abandonment. They believed that this abandonment implies that they are bad. These abandonment fears are related to intolerance of being alone and a need of other people with them. Their frantic efforts to avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors.
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2) Unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. They may idealize potential caregivers or lovers at the first or second meeting, demand to spend a lot of time together, and share the most intimate details early in a relationship. However, they may switch quickly from idealizing other people to devaluing them, feeling that the other person does not care enough, does not give enough, is not “there” enough.
3) Identity disturbance characterized by markedly and persistently unstable self image or sense of self.
4) Impulsivity as characterized by binge eating, drinking and engaging in unsafe sex.
5) Recurrent suicidal behavior or self- mutilating behavior. These are very common and often the reason why the individual seeks for help.
6) Emotional instability as displayed by intense episode of dysphoria, irritability and anxiety which last for few hours to few days.
7) Chronic feelings of emptiness.
8) Inappropriate, intense anger that results in verbal outburst and extreme sarcasm.
9) Transient, stress-related paranoid thoughts. These episodes occur most frequently in response to a real or imagined abandonment. Symptoms tend to be transient, lasting minutes or hours.
One characteristic of borderline personality disorder is a pattern of instability in interpersonal relationships. Susana never had any friends before she was placed in the institution with the exception of a few men whom she slept with a time or two. Her relationship with her parents was also difficult. Susana has grown up in an unstable environment. Having a father that is controlling and has intense anger and inappropriately aggressive in most situation and a mother who is highly unstable in mood shifting, make Susana’s relationship with her parents complicated. Although, there is no evidence that her parents have borderline personality disorder, it is known that if a parent or guardian has the condition, it is more likely that the child will develop it also. Susana’s unstable interpersonal relationship continued after she was admitted at Claymoore. She befriended Lisa, one of the patients in the ward who was a sociopath. Susana goes from thinking that Lisa is the perfect friend to hating everything about her.
In today’s society, more and more people are being diagnosed with some form of mental or personality disorder. Whether it be post traumatic stress disorder, obsessive compulsive disorder, seasonal affective disorder, attention deficit hyperactivity disorder, or some form of depression or anxiety, hundreds of thousands of Americans are afflicted with some form of psychological abnormality. I have ...
Impulsivity is also one of the criteria of borderline personality disorder. Susana displayed this characteristic by having sex with her high school professor and having sex with two people in the same day while in the mental institution. In addition, she also broke out of the hospital and she aids in drugging a nurse to sleep to steal a guitar. She was stealing her medical file also. She was also seen binge drinking, once while she was still in high school and another time with Lisa. Susana also showed self mutilating behaviors such as taking fifty aspirin with a bottle of vodka and cutting her wrist, which was the reason she ended up in a mental institution. She denied that she was trying to kill herself. She claimed that she has no bones in her wrist. These gestures fall on the criteria of suicidal and self-mutilating behavior.
Susana had a hard time being who she is. She doesn’t really know who she is. This meets the criteria of identity disturbance. As an example, Susana didn’t fit in when she was in high school. She fell asleep on her high school graduation. She had little interest on the norms of prize-giving or anything to do with what’s accepted in the society. Also, she was underdressed during her father’s birthday party and stayed in her room the whole time. In addition, she kissed Lisa while they run away. She wasn’t sure how she supposed to like her.
Emotional instability was also one of Susana’s problems. She had mood swings which suddenly intensify. As an illustration, Susana was extremely depressed when Lisa left. She didn’t want to get up. She stayed in bed the whole time and wasn’t eating. She was also mad at Valerie for forcing her to get up and submerging her in the cold bathtub. She started yelling at Valerie and uttering racial slur at her. Susana fits five of the criteria for borderline personality disorder. For this reason, she spent two years in Claymoore in order to be treated.
For many years, Borderline personality disorder was considered a mental illness only associated with adults above age 18, however in recent years mental health professionals have begun to consider the possibility of Borderline Personality Disorder being diagnosed in adolescents. Borderline personality disorder is characterized by extreme patterns of impulsivity such as promiscuous sex, spending ...
As depicted in the movie, borderline personality disorder is hard to treat because of the instability of the individual. A therapist must be firm and hard as a rock to deal with somebody with this disorder. Psychcentral.com stated that:
Many professionals are turned-off by working with people with this disorder, because it draws on many negative feelings from the clinician. These occur because of the client’s constant demands on a clinician, the constant suicidal gestures, thoughts, and behaviors, and the possibility of self-mutilating behavior. These are sometimes very difficult items for a therapist to understand and work with (psychcentral.com).
Psychotherapy is the treatment of choice for borderline personality disorder. It helps the patient learn new coping skills and regulate emotions. The initial important aspect of psychotherapy is contracting a person not to commit suicide. Suicidal ideation should be carefully assessed and monitored. In severe cases, medications are implemented and the person has to be hospitalized.
People with borderline personality disorder are often seen in the hospital because of severe depression. If a patient ends up in the emergency room, he/she shouldn’t be treated for the same problem with a new set of therapist. The patient should be referred back to his/her usual therapist in order for the treatment to be effective. Emergency room visits should be discouraged because it’s costly. A person should have a community support system that he/she can run to on emergency cases.
Antipsychotic drugs such as haldol are very useful for psychotic symptoms and help with disorganized thinking. Also, antidepressants and anti-anxiety medications are helpful during severe depressive episodes.
Self-help should be encouraged by therapists to patients with borderline personality disorder. Seeking social support in the community will ease up someone with this disorder. They can share their experiences together and can try new coping skills as a group. In the movie, Susana helped herself cope with the disease by journaling which then helped her to build a relationship with her therapist. She was able to talk to her about her experiences and was able to realize that she needs to get better.
... and antidepressants is the therapeutic mainstay. Borderline Personality Disorder and Marital Relations Borderline Personality Disorder is a mental illness which causes ... hand, the therapeutic relationship between the BPD patient and the therapist poses a dialectic tension in which they ... they easily idealize and develop attachment to other person; however, in the occurrence of conflict, their ...
Susana was eventually discharged from Claymoore. She now lives a normal life as a writer, as what she always aspired. She wrote a memoir about her life at the institution where the movie was based upon.