A Woman with Borderline Personality Disorder

         (Girl, Interrupted By Susanna Kaysen)

This piece of writing will discuss the life story of Susanna Kaysen. Susanna Kaysen is 

the author of the book ‘Girl, Interrupted and it is a fiction book based on the author’ true life 

story. Which discusses, the way her personality disturbance by prolonged and became a 

borderline in her life.  Susanna Kaysen a young woman who, admitted to McLean Hospital in 

Belmont, Massachusetts after attempting suicide when she was 18 years old. This paper will 

present the problems, possible diagnosis, personal recommended intervention strategies, and 

critique the intervention strategies presented in the book. Literature review will be discussed 

and compared with other relevant theoretical approaches. 

Presenting the problem

American author Susanna kaysen was born in 11th of November 1948 and lived in 

Cambridge, Massachusetts. Her father was an economist called Carl Kaysen a professor at 

MIT and her mother was Annette Neutra Kaysen. In 1967 Kaysen was admitted to McLean 

hospital in Belmont, Mass after attempting suicide. The novel is the autobiographical account 

of Susanna Kaysen’s life just after her graduation from high school in the late 1960s. At this 

point in her life, Susanna has no direction decides to attempt suicide, taking a bottle of aspirin 

followed by a fifth of vodka Susanna survived her suicide attempt and was then sent by her 

parents to see a psychiatrist. In response to her suicide attempts, an illicit relationship with 

her high school English teacher and running away from home she was sent to McLean 

Psychiatric Hospital after only one session with the psychiatrist. At their first meeting, of 

which Susanna still cannot recall the length, the psychiatrist immediately decided that 

Susanna would require hospitalization in a psychiatric ward. When she was 18 years old, she 

admitted herself for few weeks, but Kaysen had to stay there for eighteen months. The overall 

character of Susanna kaysen manifests by uncertainty about several life issues, such as self-

image, sexual orientation, long term goals or career choice, type of friends or lovers to have 

and which values to adopt. As well as Kaysen often felt emptiness and boredom. Kaysen had 

very nice thoughts in her life. Kaysen was dreamy and very sense of detachment in her 

several life issues. For an example the sensation of her hand born, she became convinced that 

there were no bones in her hand. That was not a delusion since Kaysen retains insight that 

these are subjective phenomena rather than objective reality. But these sensations maybe 

occurs under conditions of stress, fatigue or drug use, from healthy individuals for lasting 

only a few moments. Kaysen’s suicidal thoughts has become from negative aspect of her 

lifetime. But her boyfriend diminished the risk of serious suicidality. Kaysen’s behaviour was 

viewed as attention-seeking and manipulative suicidal attempt.  

Following a visit to a psychiatrist who was a ‘friend of the family’ Kaysen was then 

admitted to the Mclean Psychiatric Hospital, where the psychiatrist informed her that she was 

having ‘a rest’. Kaysen had to take antipsychotic meds and Dialectal group therapy at 

McLean rather having a rest. Kaysen was a bright teenager because she was very good writer 

and She perceived most of things very critically hurtfulness. When the doctor asked about a 

pimple on her face she believed the pimple had reached the stage of hard expectancy in which 

it begs to be picked. Kaysen did not like to agree the pimple has picked by her. Kaysen was 

very anxious about simple thing that normal person should not get anxious. Kaysen thought it 

must have been something more than a pimple. Kaysen critically thought about mind versus 

brain and she came with very strong explanation about it. That manifests Kaysen’s 

knowledge about biology and her discernment level. Kaysen told a memory is a particular 

pattern of cellular changes on particular spots in human’s head. Kaysen was talking about 

biological and neurological regards to mind and brain. Kaysen needed to explain about 

mental illness using her perceptions according to her experience while she suffering BPD. 

Kaysen effectively explained difference between normal person and crazy person. Kaysen 

believed a parallel universe. According to author’s personal review, the concept of parallel 

universe of Kaysen illustrates delirious thoughts in her mind. She explained in the parallel 

universe the law of physics are suspended. Furthermore Kaysen told about time difference in 

her imagine universe may run in circles flow backward and skip about from now to then. As 

well as Kaysen described the arrangement of molecules in parallel universe is fluid. Kaysen 

draw attention about these factors will find out later in future. Kaysen was not very happy 

with her parents and she did not want to talk anyone she does not like to talk. But sometimes 

Kaysen scared about life at McLean hospital. She supposed stay at hospital utterly absent 

from outside lives. In other hand Kaysen was as much refuge at hospital rather stays at home 

with her parents. Kaysen wrote in her book, the reason for signed herself into the hospital was 

her age or a court order. Kaysen did not know anything a court order and she felt very 

negative about her in that situation and decided to sign in herself. After Kaysen got back from 

the hospital, she found the differences in her perceptions of people. It has been changed. 

Before Kaysen found peculiar items instead of too much meaning. Kaysen explained the 

change was her salvation of her misperceptions of reality. According to Kaysen, she was 

wondering about was everybody seeing this stuff and acting as though they were not or was 

insanity just a matter of dropping the act. Kaysen was very unsettled with those questions. 

She supposed that anything might be something else. Kaysen wanted to negate: when she 

supposed to be awake, she asleep; when I supposed to speak; I was silence and etc.  Kaysen 

and her friends at psychiatrist hospital told the staff to refuse phone calls or visitors from 

anyone they did not want to talk to include their parents. Those incidents imply Kaysen was 

having difficulties tolerating being alone and make frantic efforts to avoid real or imagined 

abandonment. Kaysen swallowed the fifty aspirin for her humiliation and regret. Kaysen did 

mention in her book that she wanted to kill only part of herself and that intention dragged her 

into the suicide. When Kaysen survived her suicide, she began to worry about her death and 

felt compassion for her. Kaysen thought after attempting to suicide things started to blur and 

whiz. Kaysen was cheerless what she done with her life. Kaysen thought she lost her 

peripheral vision and she was scared about things change after her suicide attempt. Kaysen 

remembered not to try killing herself again.  Kaysen was terrible with her interpersonal 

relationships, she unable to maintain her relationship with her boyfriends and her parents too. 

When she was seventeen Kaysen unable to stay with sexual relationships and she was not 

happy with them. The Kaysen became promiscuous. Kaysen was thinking of the future kiss 

from her English teacher. Because he did not kiss her since they went for dinner out in New 

York. Sixteen years later Kaysen met a new, rich boyfriend. Kaysen has self-reported, 

sometimes she was too emotional and other time too cold and judgmental. They took many 

trips together and her boyfriend paid for that. But they were not very comfort with their 

relationship. Kaysen new, rich boyfriend had often attacked with her. They began the 

spending-and-attack cycle. Then Kaysen learnt not to discuss her obligations and doubts. 

Kaysen tried to make their relationship comfort. The hospital had five-minute checks, fifteen 

minutes checks and half –hour checks. The person on checks said “checks” when they 

opened the door. While Kaysen stay at hospital her boyfriend came to visit her. The person 

on checks caught them at blow job and they been put on supervised visits. Kaysen knew that 

everybody knew they’d caught Kaysen. But Kaysen kept mentioning it because it bothers her. 

When Lisa shouted “Big deal” and insult at the blow job Kaysen was very uncomfortable and 

replied her “I do not think he could do it in fifteen minutes”. Kaysen was very impulsiveness 

with sexual relationship. Several times in her life story explain that Kaysen was very 

sensitive to the way others treat her. When Kaysen was nearly twenty that mean after 

discharge from the hospital she had two jobs in her life. Kaysen made mistakes as a typist at 

Harvard billing office. Therefore Kaysen was terrified by the supervisor. The supervisor did 

not allow typists to smoke at the work place. Kaysen was the only women who smoke at 

work place. That is the reason Kaysen became as a writer, to be able to smoke in peace. 

Kaysen before her treatments at hospital had a choice about types of friends and types of 

lovers have to be. But interpersonal relationship with Kaysen and her social work explain 

gigantic difference after her treatment. According to that view Kaysen did not like her social 

worker. Kaysen maintained that interpersonal relationship and she was getting better with her 

life. Kaysen got married after she left hospital and they were really happy at their marriage 

life. But she expected after married the life will just stop. In contrast Kaysen did not quite 

right with her expectation. After Kaysen left the hospital, she kept in touch with Lisa, 

Georgina and etc. Her writing tells when a pleasure offered itself to her, Kaysen avoided it, 

her hunger, thirst, loneliness and boredom and fear were all hostile for her.  Kaysen had not 

told to anyone what she really felt and what was really happen in her life before she 

published the ‘Girl interpreted’. Doctors had not diagnosed her conceal mental issues. Kaysen 

did not allow others to know about her face scratching and her pain too. But Kasyen stopped 

scratching her face to prevent her from looking worse and kept banging her wrist. She did 

mention about wrist scratching.

Diagnosis

Kaysen doctors’ diagnosed for her several life issues and her behaviour. The 

diagnosis was fairly accurate as her picture at eighteen.  

“Needed McLean for 3 yrs, Profoundly depressed- suicidal, increasing patterns less of life, 

promiscuous might get pregnant and runway from him 4 months ago. Leaving on boarding 

house in Camb.” 

Susanna had to retrieve her medical records through the aid of a solicitor. 

Contemporary psychologists use Diagnostic and statistical manual of mental disorders (DSM-

IV) to diagnosis these symptoms. Kaysen’s story appears her symptoms of depersonalization. 

Her dreamy state and senses of detachment suggest that kaysen was suffered with 

Depersonalization. Depersonalization disorder is classified with four essential criteria as one 

of the dissociative disorders in the DSM-IV (American Psychiatric Association, 1994). 

Sierraand and Berrios (2001) defined ‘depersonalization as an experience in which the 

individuals feel a sense of unreality and detachment from themselves. Several studies 

suggested occurrences between symptoms of depersonalization and suicidality (Cem 

Atbaşoglu et al., 2001; Yoshimasu et al., 2006).  The reason for self-harm was investigated 

by several American psychologist and they established negative life events and life problems 

are thought to amplify the risk of suicidal behaviour (Heikkinen et al., 1994). Livesley, 

Jackson and Schroeder (1991) found self-harm appear to comprise a distinct component of 

personality disturbance. Furthermore, Several researches have demonstrated self-harm 

including with depression (Haw et al., 2001), anxiety disorder (Haw et al., 2001; Zlotnick et 

al., 1999) and eating disorders ((Favazza et al., 1989; Haw et al., 2001). Researchers have 

investigated self-injurious behaviour refers to a broad class of behaviours in which an 

individual directly and deliberately cause harm to them.  They illustrated such behaviour can 

include non-suicidal self-injury and that may associate with several personality disorders. For 

example; maladaptive personality disorder although NSSI is most often associated with 

borderline personality disorder (BPD; Dulit et al., 1994; Shearer, 1994). Pattison and Kahan, 

(1983) and Muehlenkamp (2005) suggested that NSSI should be considered for inclusion as a 

new DSM-IV diagnosis. Rather self-harm and depersonalization, Kaysen was suffering from 

uncertainty about several life issues, such as self-image, sexual orientation, long term goals or 

career choice, type of friends or lovers to have and which values to adopt. As well as Kaysen 

often felt emptiness and boredom. Personality disorder symptoms are diagnosed by meeting 5 

of the items in the DSM criteria. Personality disorder maybe marked by a prolong disturbance 

of personality function. It is characterized by unusual variability and depth of moods. For 

example, these moods may affect cognition and interpersonal relationships (Millon, 1996). 

The DSM 5 criteria diagnose certain symptoms; significant personality functioning manifest 

by: impairments in self-functioning (identity or self-direction), impairments in interpersonal 

functioning (empathy or intimacy), emotional liability, anxiousness, separation insecurity, 

depressively and impulsivity as ‘borderline personality disorder’ (BPD). But the impairments 

in personality functioning and the individual’s personality trait expression are not solely due 

to the direct physiological effects of a substance; as an example a drug of abuse, medication 

and etc. But some investigators have found that, under the conditions of stress, fatigue or 

drug use from healthy individuals for lasting only a few moments may affect the sensation of 

depersonalization (M. Mula et al., 2007).  The doctors at McLean estimated diagnosis mental 

disorder was ‘borderline personality’ in 1967. But these symptoms of Kaysen may confuse 

with bipolar disorder. That confusion may put Kaysen’s personality at risk begin 

misdiagnosed with bipolar disorder. Because the BPD and bipolar disorder may be related is 

that the common features of mood instability. The BPD and bipolar disorder co-occur are 

more apt to be understood as representing an interaction of biological and environmental 

forces (Magill,2004). Affective instability (Henry et al., 2001; Koenigsberg et al., 2002) and 

suicide attempts s (Fyer et al., 1988; Ruggero et al., 2007; Zanarini et al., 2008) are core 

features of both disorders. In other hand the BPD might be confused with the irritability of a 

manic episode. Impulsivity is a hallmark of BPD and the difficulty controlling anger often 

seen in individuals with BPD (American Psychiatric Association, 2000). It is important to 

find out the BPD and bipolar disorder patients’ internal function in their bodies. Because, 

according the interface differences between BPD and bipolar disorder, the biological and 

neurological function should be functioning in different ways. Numbers of studies have 

suggested strong evidences for the overlapping functional and structural neuroanatomical 

abnormalities for BPD and bipolar disorder (Blumberg, Kaufman, & Martin, et al., 2003) 

They illustrated those abnormalities involving with temporal lobe and related limbic 

structures. An association was detected between bipolar disorder and decreased medial 

temporal lobe volume. The effects were greater in the amygdala than in the hippocampus. 

Such as damages to temporal lobe regions or surrounding structure (the brain structure) may 

course of these disorders. As an example, a reduction in hippocampal volumes and perhaps of 

the amygdala may cause with BPD. In addition, the lithium to a lesser extent, are the class 

studies systematically in both bipolar and BPD. (Blumberg, Kaufman, & Martin, et al., 2003) 

The Girl interrupted does not carry any family background information regarding genetic 

factors. It is missing from doctors’ diagnosis. There might be several lines of evidence from 

Kaysen’s family supporting a possible genetic association of BPD and BD. Recent 

investigators demonstrated several particular evidences maybe converge genetic factors 

supporting for BPD and BD (Soloff & Millward, (1983). For an example one analysis of the 

first-degree relatives of borderline probands found that 38% had a first-degree relative with 

depression and 25% had a relative with pathological mood swings. Researches indicated that 

as patients endorse more symptoms of borderline personality disorder they become less 

diagnostically ambiguous and hence less likely to have been misdiagnosed (C.J. Ruggero et al., 2010))

Treatments

Misdiagnosis of BPD as bipolar disorder has serious clinical implications. Therefore 

the therapies for BPD has been developed and that is distinct from those would be used to be 

for bipolar disorder. These include long and short versions of dialectal behaviour therapy 

(Linehan et al., 2006; Lynch et al., 2006; Stanley et al., 2007), short and long term cognitive 

behavioral therapy tailored for borderline personality disorder (Davidson et al., 2006; 

Weinberg et al., 2006), metallization-based and trans- ference-focused therapy (Bateman and 

Fonagy, 2008; Clarkin et al., 2007), schema-focused therapy (Giesen-Bloo et al., 2006; 

Young, 1999) and adjunctive group psychoeducation (Blum et al., 2008). But mixed evidence 

that medications used to treat bipolar disorder is effective for borderline personality disorder 

Doctors use ‘low-dose’ of new antipsychotic medication for dissociative and identity 

problems(Binks et al., 2006). No specific psychological treatments for BPD has been shown 

to be more effective than any other, but it is likely beneficial with treatments for personality 

disorder. As an example, psychoanalytically or relationally orientated treatment (PA). 

cognitive therapy (CT) and behaviour therapy (BT). According doctors diagnosis Kaysen had 

received sufficient treatments, self –report and Dialectal group therapy.  After concerning the 

evidence, co-occurrence, neurological / biological distinctions, medication, genetic 

prevalence and longitudinal course, investigators concluded it is safe expedient to identify the 

BPD from BD inconclusive. 

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