June 1, 2000
Jun 1, 2000
17 Min read time
Unlike most of the acclaimed books that deal with the experience of mental disorder, Susanna Kaysen’s Girl, Interrupted had its impact without pushing any special agenda. Clifford Beers’s groundbreaking account, A Mind That Found Itself, started a self-help movement. Joanne Greenberg’s I Never Promised You a Rose Garden promised much more: that psychotic patients could recover their sanity with the help of a really caring psychotherapist. Ken Kesey’s One Flew Over the Cuckoo’s Nest used the mental hospital as an all-purpose metaphor for injustice and the oppression of those who are different. Sylvia Plath, Anne Sexton, and Robert Lowell, all distinguished poets, wrote about their mental disorders as revelatory confessions: a curtain was lifted. Kaysen’s memoir, on the other hand, is first of all literature: ironic, removed, more observer than participant, she knows and asks important and unanswerable questions. There are poignant descriptions of other patients and of the nurses who were her "keepers," and quick glimpses of the doctors, all of it tied together by a powerful intelligence and an impudent black humor.
Many people do not realize that, by law, they own the contents of their medical records. Kaysen obtained hers and published excerpts. Interspersed through her book they provide a target for her irony. Girl, Interrupted, which was published in 1993, 26 years after Kaysen’s 1967 hospitalization, describes an era in psychiatry, and in American life, that no longer exists. Still, the book won critical acclaim and became a national bestseller. Seven years later the motion picture version was released. Though flawed and banal, it gave Angelina Jolie the chance to play the kind of sociopathic personality that makes an actor’s reputation—she won the Oscar and Golden Globe for best supporting actress.
Kaysen grew up in Cambridge, Mass., during the 1960s, when America’s safety net of family values gave way and the adolescent passage from child to adult became a minefield of sex, drugs, and rebellious self-destruction. Hardest hit were the children of the upper classes and the liberal academic elite. The wealth, privilege, and status of their parents produced a kind of shame that pushed adolescent rebelliousness to its furthest extremes. Twelve-year-old girls at the poshest schools turned up pregnant and the "man" responsible might be fourteen or the history teacher. Teenagers dropped acid, smoked pot, and, thinking it a benefaction, turned on their younger siblings. Kaysen describes the late-1960s teenagers as "the drifting, drugged out, no last name youth universe."
Remarkably, most of these young people survived the passage, although some of them took long detours and still bear the scars. Susanna Kaysen is one of the scarred survivors, and her detour included almost two years at McLean, Harvard’s private psychiatric hospital in Belmont, Massachusetts.
I was still director of the psychiatric training program at McLean when Kaysen was first hospitalized--though I have had no professional or personal knowledge of her illness or her family. I have never discussed her case with any of her doctors or nurses (she has given them all pseudonyms), and violate no confidence or ethical obligation in what follows. I came to her book expecting another Cuckoo’s Nest diatribe against psychiatric coercion. Instead I discovered an elliptical meditation on the experience, with layers of irony, humor, and compassion, for the keepers as well as for the kept. Sketched in this slender and readable volume was the McLean I knew, but from the other side of the locked doors.
Some reviewers of the book imposed on her ellipses their own sense of narrative, as would the subsequent film. In that more orderly narrative, Kaysen’s McLean hospitalization is precipitated by a suicide attempt; likewise, the film begins with Winona Ryder as Kaysen having her stomach pumped out. Psychiatric hospitalization after a major suicide attempt was pretty much the norm in 1967. But read the memoir carefully and you find that this suicide attempt took place two years prior to her McLean hospitalization. It was not the precipitating event, and she never tells her readers what, if anything, was. In her memoir, the doctor’s decision to hospitalize her is presented as an enigma that sets the tone for her reflections. Why did he send me to McLean? Why did I agree to stay there? What does my diagnosis, Borderline Personality Disorder, really mean? Thirty-three years later these questions are even more perplexing and difficult to answer.
In an earlier day, McLean was famous for its Old New England Brahmin patients—the kind of people Henry James described in The Bostonians. Frederick Law Olmsted designed the grounds, and at one time its trees and shrubbery rivaled the Arnold Arboretum. There were acres of greenery and what one might even call forest around the hospital on the hill in Belmont. Most of the patients were expected to spend the rest of their lives at McLean; it had been organized accordingly as "custodial care." There was a large greenhouse, a library, a one-hole golf course, a one-lane bowling alley, a tennis court, and a gymnasium. Patients were served tea in the afternoon and sherry before supper. Legend has it that one of the hospital’s so-called cottages was an exact replica of a woman’s home in Brookline. One night, her family took her for an automobile ride that ended in the identical McLean Hospital building. The new patient never knew the difference. The purpose of this remarkable exercise in duplicity has always baffled me, but it says something about the McLean style in that bygone era when the psychiatric hospital was essentially a luxurious rest home. Although it might seem an odd thing to say about a mental hospital, the old McLean had real charm. It looked like a college campus. The grounds were beautiful, and the mad but polite and dignified patients seemed to be the guests of the exclusive Harvard institution their ancestors had founded.
I began my own training in psychiatry there in 1956, when a sea change was underway. By the time Kaysen was admitted in 1967, McLean had lost much of its old-fashioned charm. The hospital had been transformed from a rest home into a treatment center specializing in long-term, intensive psychoanalytic therapy. Although we no longer assumed our patients would retire to McLean, we did expect that hospital treatment would be measured in months and years not days and weeks. Looking back, it is difficult to understand how we all could have been so convinced that long-term psychoanalytic therapy would cure serious mental illnesses like schizophrenia and bipolar disorder. But reading anecdotal accounts like I Never Promised You a Rose Garden, and meaning well, we threw ourselves into the effort.
The patient population also began to change in the 1960s, when the first casualties of Kaysen’s "no last name youth universe" began to arrive. These were kids who dropped acid every day and found their own reality; some also did heroin, speed, and barbiturates (cocaine had not yet arrived). Some actually had psychiatric disorders, which they were treating with their own drugs in their own ways. Feeling anxious or lonely—smoke pot. Worried that you’re losing your mind—take acid and see how far you can go. But most troubling to their parents were the self-destructive behaviors, not just having casual sex with strangers but burning themselves with cigarettes, cutting their arms with razors, making their own primitive tattoos, and worse. One psychiatric pundit said that "hippiephrenia" was replacing schizophrenia. They looked and acted crazy by conventional standards but they did not fit into any of our diagnostic categories. We eventually had to create a new diagnosis for patients like Kaysen: Borderline Personality Disorder. It was by no means easy for us to decide when someone had crossed the border from hippie to hippiephrenia. No wonder, then, that the patients were confused: most of their symptoms did not bother them. What we called substance abuse, they called tripping and getting high; what we called failing in life, they called dropping out; what we called promiscuity, they called no big deal.
McLean was transformed by these unruly young patients into the kind of institution Kaysen describes—a sort of reform school. There the nurses ("keepers") had the endless task of controlling the "acting out" of angry, rebellious, self-destructive teenagers. We had the grandiose idea that we could create within the hospital a "therapeutic milieu" for them, a corrective psychological and social environment that would buffer their anxiety, assist their reality testing, and help them control their impulses. Milieu therapy was the shibboleth of psychiatry in the 1960s; it had replaced custodial care. What we failed to appreciate sufficiently was this: even with all the resources and staff of our hospital, the locked doors, and the loss of privacy, the real milieu would be the other disturbed patients, and that might or might not be therapeutic. We certainly had no hard evidence at the time that long-term psychoanalytic therapy and long stays in our therapeutic milieu could help young people with hippiephrenia, but we were all in psychoanalysis ourselves and we gave them the same treatment. Many, like Kaysen, got better. We thought we were helping them, but perhaps they just grew up.
Kaysen’s style is minimalist. Her descriptions of what she experienced as symptoms have an abstract flatness: "Here comes the I’m no good thought. That takes care of today. All day the insistent dripping of I’m no good. The next thought, the next day, is I’m the Angel of Death. This thought has a glittering expanse of panic behind it, which is unreachable. Viscosity flattens the effervescence of panic." Kaysen seems to realize that she was depressed. Her deeper understanding of these and other symptoms can be found in a chapter entitled "Elementary Topography." "My ambition was to negate …. My hunger, my thirst, my loneliness and boredom and fear were all weapons aimed at my enemy, the world. They didn’t matter a whit to the world, of course, and they tormented me, but I got a gruesome satisfaction from my sufferings. They proved my existence. All my integrity seemed to lie in saying no." This willful self-assertion, call it negation, is the aspect of the human condition most neglected by psychoanalysts. It does almost everything that Freud supposed the Death Instinct did, and there is nothing exotic or mysterious about "saying no." The wisest of McLean’s psychiatrists warned us never to underestimate the steel-like power of negation. Susanna Kaysen knows exactly what he meant.
The doctor who referred Kaysen to McLean described her as, among other things, "promiscuous." This was not to Kaysen’s mind a symptom, and she objects to the label. She admits to owning nothing but mini-skirts no larger than a handkerchief and enjoying being flirtatious. But she understandably resents a middle-class double standard being applied to her. How many partners could a young man have before a psychiatrist called him promiscuous? Still, it does seem that her sexual behavior was part of her war with the world, an act of mini-skirted defiance. For example, as part of McLean’s reform-school approach to milieu therapy she was on five-minute checks by the nurses, and when she had male visitors, the door to her room was to be kept ajar. The nurses’ notes, reproduced in the memoir, record a nurse opening the door to see Kaysen seated on the floor and her boyfriend moving away zipping his fly. This official entry is followed by Kaysen and her fellow patients’ defiant discussion of oral sex and what sexual acts can be performed in five minutes.
These young women certainly do not seem to be discussing painful symptoms; they sound more like sex-workers. That, of course, is part of Kaysen’s ironic humor. Joking aside, why these young women and Kaysen engaged in these activities is never discussed. She had an affair with her high-school English teacher, who got fired for it. He escorted her to New York for a weekend, took her to the Frick collection, and showed her the great Vermeer painting, Girl Interrupted in her Music Lesson, that gives the memoir its title. But she never gives her reader any sense of what motivated her--desire, desperation, or simply the wish to flaunt her "no big deal" attitude toward sex. It is also quite possible that she doesn’t know why she did these things, or perhaps she did them to prove to the world thatshe was prepared to do anything.
Kaysen’s memoir reveals almost nothing about her parents, although she includes the part of the hospital record identifying her father as the director of the Institute for Advanced Study, in Princeton, N.J. This disclosure baits a hook for the curious; but she goes beyond it only to the extent of restating a theory endorsed by family therapists of that era. They referred to the family member who ended up in the mental hospital as the "identified patient," on the premise that the real sickness was in the family dynamics. Here is Kaysen’s version: "Lunatics are similar to designated hitters. Often an entire family is crazy, but since an entire family can’t go into the hospital, one person is designated as crazy and goes inside…. Most families were proving the same proposition: We aren’t crazy, she is the crazy one." Kaysen never explains how she became the designated hitter, nor does she ever indicate in what ways, if any, her family was crazy. This is definitely not the contemporary narrative of childhood abuse and trauma that caused mental disorder. Kaysen was not suicidal, not psychotic, and not locked up against her will. So why did she spend almost two years at McLean Hospital? Part of the answer—and Kaysen may not fully appreciate this—is that, in 1967, such long-term, in-hospital care was thought to be the best treatment that money could buy. It was the fashion at all the finest private psychiatric hospitals—the Hartford Retreat, Menninger’s, Silver Hills, the Yale Institute, Chestnut Lodge. Today, with managed care controlling the purse strings and the decisions, there would be no interrupting of her girlhood. She would probably be given Prozac and referred to a social worker for counseling. How times change!
Spending two years in one of America’s best psychiatric hospitals for reasons that no longer make sense is a tragic waste, but it is by no means obvious that it is the kind of tragedy that makes for a good movie. McLean’s five-minute checks may have invaded Kaysen’s privacy, but the hospital was no snake-pit. And Kaysen’s girlhood had been interrupted long before she came to McLean. And that negating, rebellious, willful, privileged, mini-skirted teenager is not particularly easy to bring to life as the sympathetic heroine of a film. And Hollywood’s usual good guy/bad guy stereotypes of psychiatrists dissolve in the acid of Kaysen’s ironic prose. It is unlikely that any studio would have seen the makings of a movie in this memoir.
In today’s Hollywood, however, the stars have more money, more leverage, and often more artistic ambition than the studios. Winona Ryder read Girl, Interrupted and immediately identified with Kaysen’s account of being sent to a psychiatric hospital. She knew from personal experience what that could mean. While still a teenager, the brilliant and precocious Ryder was chosen "The Female Star of Tomorrow" and was nominated for a Golden Globe. The next year, she was admitted to a psychiatric hospital for panic attacks and, like Kaysen, worried about her sanity. Ryder identified with Kaysen’s story, as do many women who read it. She wanted to make the movie, and when producer Doug Wick bought the rights, she approached him about playing Kaysen.
The first, and perhaps the most difficult, task was to find a screenwriter who could turn the memoir into a film. Three screenwriters, including eventual writer-director James Mangold, are credited with working on that project; I suspect several others tried their hands as well. What emerged at the end has little to do with Kaysen, her irony, or her memoir. In fact, the screenplay has split Kaysen’s personality in two parts. Jung thought that everyone had a male and a female side--the animus and the anima. The Kaysen of this film is left with the anima while all her animus is given to another patient, Lisa.
The part eventually written for Ryder seems more faithful to her psychiatric history than to Kaysen’s. Ryder is a luminescent beauty whose face can convey every nuance of angst and human vulnerability; that is her stock and trade as an actress. For most of this film she is a deer caught in the headlights. Again and again, the camera finds the panic in her large brown eyes. Meanwhile, Kaysen’s willful rebellion, her sense of negation, and her willingness to do anything to prove she is prepared to do anything, all has been given in the screenplay to Lisa, played by Angelina Jolie. She is Jack Nicholson’s Randle McMurphy, taken right out of One Flew Over the Cuckoo’s Nest. McMurphy was a malingering criminal, a sociopath, who thought a few years in a mental hospital would be easier than serving his prison sentence. He ends up getting lobotomized. Lisa, who is also sociopathic, seems to take pleasure in being cruel in the name of being honest. The film is about the relationship between the brazen, pouty Lisa and the vulnerable, frightened Susanna. Jolie does all the outrageous bits and Ryder all the wide-eyed reacting. The erotic undercurrent of this animus/anima relationship is made visible on the screen when the two escape together from the hospital and celebrate their freedom by kissing each other on the lips. This Thelma and Louise relationship is not in the memoir. In the film, this "affair" pulls Kaysen out of the brooding introspection that seems to be the form of her illness. She has the strength to break it off when she recognizes that Jolie’s sadism has no limits.
The film is put together with clichés taken from other movies (we even get the Wizard of Oz) rather than the nuanced ironies of Kaysen’s memoir. In an attempt to attract an audience, parts were invented for Whoopi Goldberg, as a tough-love nurse, and Vanessa Redgrave, as a pontificating psychiatrist. They seem to be rerunning their own past performances, as does the ever-vulnerable Ryder. Even Jolie’s Oscar-winning performance is a bravura version of Nicholson’s McMurphy and other movie characters. And the narrative that Mangold imposes on Kaysen’s ellipses is a mystification of mental disorder. Unable to capture the irony of the memoir, he substitutes surrealism and transforms McLean into the Land of Oz.
The most striking example of the difference between the memoir and the film—and the most striking banalization of the original—involves Kaysen’s account of her unexpected visit from James Watson. Watson, along with Francis Crick and Maurice Wilkins, won the Nobel Prize for discovering the Double Helix—a discovery of what might be called the secret of life. In the book, Watson, a friend of her family, turns up at McLean to visit Susanna, who wonders if he has come to tell her the secret of life. Instead, he offers to help her escape with him to England. What exactly this invitation means and entails is unclear. Kaysen wonders mischievously whether escaping to England with Watson is "the secret of life." The teenager declines, and Watson is sent off in his brand new bright red sports car, the spoils of his Nobel Prize. The impact of this underplayed scene on the reader depends very much on whether you get all of the levels of irony. One must first believe that the real James Watson actually made this proposal to a teenage girl in McLean Hospital. He apparently did this without consulting her parents or any competent professional, and without any sense of the psychological implications of his proposal. She had the good sense to refuse the offer—at least that is how Kaysen tells it. Think of what this says both about Watson’s judgment and Kaysen’s mini-skirted magnetism. This vignette certainly does not fit the film’s story of an innocent and vulnerable victim. But it does tell us something very real about what life was like in the late-1960s, when precocious and beautiful teenage girls suddenly lost the safety net of middle-class values, and so did the older men who might take advantage of the opportunities. Little girls like to pretend to be grown-up, but it can get complicated when the real grown-ups act convinced. Kaysen never uses the analogy, but her memoir is among other things a 1960s version of a flirtatious Susannah and the Elders.
The filmmakers must have had a reason for letting Watson off the hook—but it cannot be that the scene as written by Kaysen lacked drama. In any event, Mangold and co-writers place Watson’s offer in the mouth of an age-appropriate boyfriend. His number has come up in the Vietnam War draft and he wants Susanna to escape with him to Canada. This scene, like the entire film, is banal and false, where Kaysen’s memoir was extraordinary and has the troubling ring of truth.
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June 01, 2000
17 Min read time