PSCY Essay

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Girl Interrupted Character Analysis

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The film Girl Interrupted chronicles eighteen months in the life of Susanna

Kaysen, the main character and narrator, after her attempted suicide and subsequent

institutionalization. Susanna celebrates her high school graduation by swallowing a

bottle of Aspirin and chasing it with a bottle of vodka. While she insists she simply

had a headache, it is suggested by the therapist she speaks with that she is suicidal,

and would best address her mental health by spending some time in the Claymoore

Psychiatric Facility. Throughout her time in Claymoore, Susanna meets and

befriends a number of girls with a variance of disorders. One girl in particular, Lisa,

plays a prominent role in Susanna’s experiences at Claymoore, and greatly

influences the trajectory of her therapeutic progress. Lisa is a sort of leader in the

facility, exerting power over the girls who in turn either idolize or revile her. Lisa is

frequently shown talking back to the nurses and breaking rules, regularly causing

excitement in the ward. At one point, Susanna, Lisa, and a group of girls break into

the psychiatrist’s office and read their case files. During this scene the girls discuss

their disorders as well as the notes made by the psychiatrist substantiating his

diagnoses. While the doctor’s opinions hold weight, Lisa’s noted behaviors are

those that can be attributed to more than one disorder, and throughout the film traits

are revealed that could complicate her cut-and-dry diagnosis. When making any

diagnosis, it is important to consider all options, as well as the possibility of mixed

features or comorbidity of disorders.

The personality disorder Lisa is meant to represent in the film is Antisocial

Personality Disorder (ASPD), defined by the DSM-V as those with an utter lack of

regard for and violation of the rights of others. This pattern of behavior must be

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present from the age of 15, and the individual must meet three or more of the listed

criteria. The first criteria consists of an inability to conform to social norms with

respect to lawful behavior, and while our reference for Lisa’s behavior is mainly

within the confines of the institution and we do not have a reference for legal

behavior, we do see numerous instances where she breaks facility rules. There is a

clear pattern to such behavior, as Lisa is first introduced to the audience after being

caught and returned by the police after escaping the institution, and it is explained

to the viewer that this was not her first escape. Aside from her numerous escape

attempts, Lisa is also seen rallying the other girls and collectively breaking into the

psychiatrist’s office to read their records. Lisa shows pride in her diagnosis, sharing

her report with the other girls, gleefully explaining that those with the disorder are

rare and hardly ever female. Other examples of Lisa’s rule breaking include

drugging a nurse to break into the music room and take instruments, as well as

habitually cheeking her pills and instead taking those of other patients. The next

criteria requires the individual to display deceitful or conning behavior, in order to

gain some personal profit or pleasure. In order to prevent a nurse from walking in

on her friend Susanna engaging in sexual behavior with a male guest, Lisa attempts

to distract her, then threatens to jam a pen in her aorta to hold her attention. Such

behavior is clearly manipulative, and though her behavior may seem altruistic, it is

likely that she has ulterior motives in Susanna’s usefulness as an ally, or even that

she was engaging in a thrill-seeking behavior.

Consequently, Lisa does not meet the ASPD criteria of chronic impulsivity

and lack of forethought. Though we see her engage in behaviors that may not have

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been well thought out, when Lisa makes her last escape attempt in the film, she has

a clear plan to run to the home of a released patient, Daisy to lay low for a day, then

travel to Disney World to get a job as a princess. Though her goals may not be

completely realistic, her behavior leads us to believe she has made some sort of an

advance plan, giving thought to where she would go and how she would get there.

Conversely, Lisa does exhibit irritability and aggressiveness indicative of ASPD

during the film, becoming violent with staff as well as yelling and verbally

attacking a woman in an ice cream parlor in defense of her friend Susanna.

However, though Lisa seems to truly care for some of her friends, and acts in ways

that seem to be in effort to take care of them, she also exhibits a lack of remorse for

hurting others. A pivotal moment in the film occurs after Lisa and Susanna escape

the institution together and flee to Daisy’s apartment. Daisy and Lisa are shown

throughout the film as not getting along; Lisa frequently barges into Daisy’s room

simply to upset her, and teases her for some of her strange eating behaviors. While

in the apartment, Lisa begins to rant about how Daisy’s early release was

undeserved, yelling how everyone knew that she and her father were involved in an

incestuous relationship, and accuses her of enjoying being his replacement wife.

Lisa says horrible things to Daisy, despite Susanna’s pleas for her to stop, and her

hurtful words lead Daisy to commit suicide the next morning. Upon encountering

her dead friend, Susanna breaks down, while Lisa, on the other hand, acts as though

she is completely unaffected by the turn of events, going so far as to steal the

money from Daisy’s robe pocket before fleeing the residence. Overall, Lisa does

meet the minimum requirements for diagnosis of Antisocial Personality Disorder,

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given the assumption that the diagnostic behaviors began at the age of fifteen.

However, it is important to consider other options before getting comfortable in a

diagnosis.

Lisa’s behavior may in fact better reflect that of a borderline patient than an

antisocial one. BPD is characterized by a pattern of instability in interpersonal

relationships as well as self-image, and diagnosis requires that five of the listed

criteria be met, the first being frantic efforts to avoid real or imagined

abandonment. Lisa is terrified of being abandoned, so much so that when Susanna is

set to be released, Lisa steals her journal, reading it aloud to the group of girls,

mocking her then chasing her and attempting to attack her with a syringe. The

thought of Susanna leaving is too much for Lisa to handle, so she tries to get her to

break down so she will be unable to leave the institution and will stay with her.

Consequently, another DSM criteria for diagnosis is a pattern of unstable and

intense personal relationships characterized by alternating idealization and

devaluation. Lisa displays a highly devalued relationship with Daisy, caring little

for her hurt or even her death, causing her pain with little thought to the

consequences. She frequently taunts Daisy while in the facility, and then lashes out

at her in her apartment, despite the fact that Daisy was providing her with help and

a safe place to stay. She is also seen continuously blowing cigarette smoke in the

face of another seemingly catatonic patient, showing her lack of regard for the

comfort or personal space of others. Throughout the film there is no evidence of an

unstable sense of self, with Lisa seeming confident in her self-image, yet towards

the end of the film, when Lisa has cornered Susanna after stealing and reading her

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journal, she breaks down asking why nobody ever tries to push her buttons the way

she pushes theirs. Lisa asks why nobody ever tells her the truth; that she is a whore,

that her parents wish her dead, and Susanna responds that it is because she is

already dead. In this moment she breaks down in tears, and it becomes clear how

much of Lisa’s confidence is a farce, and that she does indeed meet the third

diagnostic criteria of a disturbed sense of self. Further, Lisa exhibits impulsivity in

multiple potentially self-damaging areas. While sexual promiscuity is not seen in

Lisa’s behavior at the institution, she is sexually suggestive with a clerk at the ice

cream parlor, and later mentions servicing men at gas stations for money while on

the run. Lisa is also seen taking Daisy’s valium, exhibiting signs of substance

abuse. Further, Lisa fulfills the criteria of both affective instability and intense

anger as displayed in her previously discussed outbursts throughout the film; with

the nurses, with the woman at the ice cream parlor, and with other patients, namely

Daisy and Susanna. Overall, throughout the film we see Lisa exhibit behaviors that

more accurately supports the diagnosis of Borderline Personality Disorder than

Antisocial Personality Disorder, however, there is another disorder that may also

explain her behavior.

Narcissistic Personality Disorder (NPD), characterized by a need for

admiration, lack of empathy, and pattern of grandiosity, may also substantiate

Lisa’s behavior. To fulfill the diagnostic criteria for NPD, Lisa must meet five or

more of the given personality patterns. Lisa is depicted as an individual with an

exaggerated sense of self-importance, reigning as the self-imposed leader of the

girls in the ward, ignoring the fact that many don’t particularly like her. Further, as

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evinced by her pride in her diagnosis, and claims of rarity, it is clear Lisa believes

that she is special and unique, another benchmark of NPD. Lisa also displays

expectations of favorable treatment, anticipating that the nurses would be happy to

speak with her, and threatening self-harm when not attended to by others. She also

expects the girls to do as she tells them, and shows surprise and anger when

Susanna chooses not to flee with her from Daisy’s home after her suicide.

Furthermore, Lisa takes advantage of others frequently, a prime example being her

relationship with Daisy, in which she takes her pills as well as uses her for a place

to hide after escaping the facility. Additionally, Lisa’s lack of empathy that

supported the initial diagnosis of ASPD, is also relevant to a diagnosis of NPD.

Overall, it is clear that Lisa can meet the diagnostic requirements for more

than one personality disorder. Further, individuals with one personality disorder

often meet the criteria for a second personality disorder, with Borderline

Personality Disorder commonly co-occuring with either Narcissistic or Antisocial

Personality Disorder (Grilo, Sanislow, & McGlashan, 2002). As such, the question

comes down to whether Lisa is an example of a patient presenting with a co-

morbidity of multiple personality disorders, or simply features a personality

disorder with mixed traits. Given the overlap of diagnostic criteria between the

three disorders, and the fact that they are all listed under Cluster B disorders,

known as the erratic cluster, I believe Lisa’s behavior to be best explained by the

presence of a personality disorder with mixed antisocial and borderline traits.

Though she meets some criteria for narcissism, the traits she exemplifies are those

already supporting a diagnosis of ASPD or BPD, leading to stronger support of the

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two earlier diagnoses. This mixed-trait diagnosis sets precedent for the unique

combination of her manipulative behavior, fear of abandonment, nonconformity,

bouts of anger, and lack of empathy.

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References

Cooper, A., Ronningstam, E. (1992). Narcissistic personality disorder. American Psychiatric

Press Review of Psychiatry, 11, 80-97

Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013).

Washington, D.C.: American Psychiatric Association.

Grilo, C., Sanislow, C., & McGlashan, T. (2002). Co-occurrence of DSM-IV personality

disorders with borderline personality disorder. Journal of Nervous & Mental

Disease, 190(8), 552-554.

Hiatt, K., & Newman, J. (2006). Understanding psychopathy: The cognitive side. Handbook

of Psychopathy. New York, NY: Guilford Press.

Mangold, J. (Director) & Kaysen, S. (Writer). (1999). Girl, Interrupted [Motion picture].

United States: Columbia Pictures

Stuart, S., Battaglia, M., & Grove, W. (1998). The co-ocurence of DSM-III-R personality

disorders. Journal of Personality Disorders, 12(4), 302-315.