“Girl, Interrupted”: Mental Illness Analysis


James Mangold’s film “The Girl, Interrupted” was based on the autobiographical book by Susanna Kaysen, who spent two years in a psychiatric hospital. This is the story of a fifteen-year-old girl who spent one year in a psychiatric hospital after trying to commit suicide. The film takes place in the 60s in America during the time of the aggravation of socio-political conflicts, which resulted in mass disillusionment and youth riots. Susanna Kaysen is not a child of her time: she is lonely, depressed, disappointed in the values and aspirations of her surroundings. Half of her peers get married and have a couple of offspring by the age of twenty. The other half runs away to San Francisco and lives in hippie communes in an eternal LSD frenzy.

At this time, she is torn by the inability to understand what she wants. Susanna had just graduated from high school, and she is the only one of the graduates who refused to study further. This fact caused misunderstanding, surprise, and discontent among teachers and friends. Then a young, anxious, physically, and emotionally fragile Susanna ends up in a psychiatric hospital. After a failed suicide attempt, she is sent to the Claymore Psychiatric Clinic.

She signs consent for treatment there, not suspecting that two weeks of “rest” can turn into a whole year. Susanna Kaysen is played by Winona Ryder; the actress gave her all, vividly showing her heroine’s feelings, emotions, and deep and suppressed pain. The film’s shooting took place in an actual psychiatric clinic located in Harrisburg, Pennsylvania. The development of conflict and characters, the play of actors, the atmosphere of a psychiatric clinic, camerawork, and even the transitions between scenes are made according to the best American standards.

Borderline Personality Disorder in DSM-5

The diagnosis with which Susanna is put in a psychiatric hospital first appeared in the American Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 (American Psychiatric Association, 2013). It belongs to the category of “Personality disorders” — it is a borderline personality disorder. Susanna feels depressed and empty; she experiences intense feelings of nervousness, often arising in response to interpersonal stress and anxiety about negative feelings of past unpleasant experiences and possible future events. The patient has a sense of fear, timidity, threats from uncertainty.

Another criterion observed in a girl is a significant decrease in interest or pleasure in almost all activities, loss of desires, and taste for life. Also, Susanna has such a symptom of borderline personality disorder as fatigue and loss of energy. Her activity has dropped to zero; she can not start doing something, and there is no motivation.

The heroine feels useless; she has developed an inflated sense of guilt. Communication with Lisa can be associated with another criterion of borderline disorder: poorly developed, unstable self-image. This is due to self-criticism, a chronic feeling of emptiness, and dissociative states under stress. As with most patients with borderline personality disorder, the girl has decreased ability to concentrate; her attention is disturbed. In addition, she also has such an important symptoms (because of which Susanna was admitted to the hospital), as repeated thoughts about death, plans to commit suicide, and suicide attempts. Thus, the patient has most of the symptoms of borderline personality disorder indicated in the DSM-5.

The Accuracy of The Depiction

The main character Susanna is in a borderline state and has depression with exogenous causes; the image of the disease can be considered quite realistic. As she remembers herself, “all her life she was like this”: taciturn, not cheerful, she never smiled. Susanna tried to commit suicide by washing down an aspirin with vodka, but she does not admit that she wanted to end her life. Emotional instability associated with endocrine restructuring and vegetative instability is a frequent companion of adolescence.

The emotions are highly intense; teenagers quickly move from joy to sadness and vice versa. Future adults tend to fixate on negative experiences, which makes feelings long-lasting, and emotional impulses tense. Susanna, a girl who made a suicidal attempt, describes her condition that preceded this episode in such terms: “Feel my hand, there are no bones in it.” She said: “Something bad was happening with my perception of people. When I looked at someone’s face, I often couldn’t read it in any way”. Susanna also claimed: “Instead of seeing a lot of feelings in faces, I didn’t see anything in them” (Mangold, 1999).

From these self-reports, it can be seen that the girl faced violations of perception of the surrounding reality and herself, corresponding to depersonalization-derealization disorders. Other experiences are more consistent with the description of the symptoms of negativism: “My whole world, filled or empty, only provoked the denial. When I had to get up, I stayed in bed; when I had to talk, I was silent; when some pleasure was waiting for me – I avoided it” (Mangold, 1999). Outwardly, Susanna looks depressed; her facial expressions are frozen, and she is fenced off from the surrounding reality; she manages to fall asleep right during the solemn graduation ceremony at school. This clinical picture does correspond to the characteristics of a depressive episode to consider the image of a mental illness realistic.

Psychopathology in Parents

Symptoms of psychopathology can be traced not only to Susanna but also to her parents. Susanna’s father works in economics, he is a careerist and is often on the road. Her mother is a housewife whose suspiciousness and emotional lability do not allow her to get closer to her daughter. Susanna’s mother is more concerned about the opinions of others than the feelings of her own daughter. Often, she does not understand that her actions offend or hurt her daughter. At her father’s birthday party, Susanne’s mother pushes her to say hello to a friend and at the same time hisses in her ear: “What are you wearing?!” (Mangold, 1999). She couldn’t even take her daughter to the clinic but only watched her from afar and cried.

The relationship between the main character and her parents is strained and devoid of mutual understanding. Communication with them causes negative emotions; Susanna’s parents instill a constant sense of guilt in her. They devalue the girl, criticizing her desire to write, her studies, and her achievements. Their comments lower her self-esteem and present everything as if the girl and all her actions are worth nothing. There are no scenes in the film where the mother or father tries to talk to her or somehow establish contact. Strangers do it for them: a family friend, medical staff at the clinic, etc. Thus, the parents of the main character also have psychopathologies: for example, the excessive concerns of the mother are a signal of her own borderline state (Comer, 2010). Her chronic pathological fear may indicate the presence of an anxiety disorder in a woman.

Risk Factors

The main risk factor was undoubtedly Susannah’s childhood; the viewer learns that after Susanna fell from the crib and broke her leg, her mother began to tie her up. The parents tied the girl to the furniture as a child so that would not fall and hurt herself. When a child is in a forced immobile position for quite a long time, develops a passive attitude to life, which may have caused depression. In addition, it can be assumed that such elements of education, coupled with increased maternal anxiety, could negatively affect the future fate of Susanna. Anxious parents raise anxious children, and they are constantly depressed; such children are passive, constrained, timid, unsure of themselves, and feel guilt due to frequent reproaches. They have difficulties interacting with the surrounding world, which seems hostile and frightening: life, according to Susanna, consists of “pitfalls, ghosts, quicksand” (Mangold, 1999).

The next risk factor is the constant manipulation of Susanna with the help of guilt. Even a family friend tells her: “Susanna, you constantly cause pain to your loved ones” (Mangold, 1999). Guilt is a powerful destructive feeling; if a person is taught from childhood that they are the source of all troubles, they subconsciously begin to look for punishment. In adulthood, self-punishment occurs through various ways of self-destruction (mutilation, drug addiction, alcoholism, promiscuous sexual relations, suicide). Against the background of her peers trying to enter universities, Susanna seems even more worthless and hopeless. In addition to everything, there is a threat of exposing a sexual relationship with a family friend; as a result, she decides to commit suicide.

Protective Factors

Susanna’s mental disorder developed due to a complex interaction of social, psychological, and biological factors. Such events in the girl’s life as graduation from school, not meeting the expectations of teachers and parents, and an affair with a married man contributed to the activation of protective factors. In numerous memoirs of Susanna, one can trace the neglect of her parents, for whom it was essential to save face in front of colleagues and neighbors. She experienced the dissatisfaction of teachers when she decided not to continue her studies, the harassment of a friend of her father, and painful procedures after an attempted poisoning.

However, throughout history, it is impossible to separate the girl’s successes or any joyful moments. The triggered protection factor erased everything that Susanna could rely on to restore her identity. The same protection factors also affected the girl’s bodily sensations, dulling them; according to Videler, Hutsebaut, Schulkens, Sobczak, and Alphen (2019), this made it possible to harm her body. At the beginning of the story, Susanna says that she has no bones in her hand.

The mental disorder prompted the activation of such a protective factor as isolation, which in the case of Susanna did not allow sharing her experiences with relatives and doctors. This factor makes the girl deny the suicide attempt to the last, and does not make the seriousness of the situation clear to her, which significantly complicates the course of treatment. Also, Susanna has activated such a protection factor as an “unsuccessful attempt to run.” To escape from her unpleasant experiences, Susanna enters into casual relationships with men, uses drugs, and attempts suicide.

Therapeutic Orientation

Susanna’s condition was called borderline; the therapy for it included hospitalization, taking medications, attending a course of psychotherapy, and writing a book (journaling). In the treatment course, the girl processes childhood insults, and harmful parental attitudes, learns to control herself, and accepts herself as she is. The therapy aimed to create the primary underlying deficiency in a person with a borderline disorder which is a stable secure relationship with clear boundaries. Feelings that have not found a way out in the client’s childhood are turned to the psychologist as a substitute for the parent figure. In addition, an important aspect was working with guilt; the borderline client had a lot of toxic shame imposed on her by her parents.

According to Chanen, Nicol, Betts, and Thompson (2020), any interpretation of her behavior involuntarily caused guilt and a desire to defend herself. Initially, Susanna devalued what is happening in therapy, the therapist himself, and the results achieved; she did this because of the specifics of her violation. However, the treatment has achieved its main task to create and maintain stable boundaries, discuss the difficulties of following the rules in therapy, and gradually create trust in the relationship. The treatment began to benefit the girl; in addition, Susanna begins to write a diary about everything that happens to her, which also helps her to get better.

Expected Outcome

Susanna began to go to a therapist actively; every day, she was getting better and better. At the end of the film, she returned home and became “normal” – active and cheerful. The turning point in Susanna’s relationship with the disorder, which increased her chances of recovery, was a combination of different factors. They were the kind attitude of the senior nurse, medical treatment, friendship with other patients, and small joys from communicating with a Lisa.

Taking care of the cat gave a new meaning to the girl’s life, and keeping a diary was an outlet for pain and frustration, and recorded written evidence of small successes. According to Fonagy, Luyten, Allison, and Campbell (2017), it is impossible to single out the only factor contributing to recovery, but all of them together gave a result. The ability to record her experiences and analyze relationships with other patients during therapy helped the girl significantly.

Although Susanna’s recovery was slow and sometimes there were steps back, it happened steadily. At first, she admitted that she tried to commit suicide; then she got rid of the feeling of guilt and learned to say “no” to the desires of others. After facing the real death of her friend, she realized that there is nothing attractive about death. At the final medical examination, she said that she got a job in a store, but she does not give up her dream of becoming a writer. This means that she has learned not only to coexist with the surrounding reality but is also ready to realize her true desires.


The film not only allows reflecting on the psychopathological picture of depression with a predominance of depersonalization and derealization symptoms. It also focuses on the problem of long-term residence of young people in a psychiatric hospital (in the film, during a period of one year). In addition to the actual emotional experiences and disorders, the main character faces existential problems in a private psychiatric clinic. She deals with a total lack of freedom, supervision, loss of privacy of life and personal space, isolation, loneliness, and fear of death. Not every parent will have the funds that the heroine talks about ($60 a day) to provide an opportunity for their child to receive help in the private clinic (Mangold, 1999). Even these privileged conditions are considered by the heroine as a permanent freedom restriction.

This view should be considered when providing psychiatric care at the inpatient stage, especially in relation to children and adolescents with mental disorders. The necessary control and safety measures should be carried out, taking into account a respectful and careful attitude to the patient’s personality. The child or teenager should be able to integrate the experience of hospitalization into his life path and not treat it exclusively as negative, critical, and unfavorable. One of the methods that can help in this issue in specialized adolescent departments is creating conditions for the realization of the innate need for initiation. The creation of a system of fines and rewards for behavior during hospitalization will contribute to the transition of a teenager to a new social and personal status.


American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: DSM V. Washington, DC: American Psychiatric Publishers.

Chanen, A. M., Nicol, K., Betts, J.K., & Thompson, K. N. (2020). Diagnosis and treatment of borderline personality disorder in young people. Current Psychiatry Reports, 22(25), 114-135.

Comer, J.R. (2010). Abnormal Psychology. New York: Worth Publishers.

Fonagy, A. J., Luyten, R., Allison, E., & Campbell, C. (2017). What we have changed our minds about: Part 2. Borderline personality disorder, epistemic trust and the developmental significance of social communication. Borderline Personality Disorder and Emotion Dysregulation, 4(9), 140-147.

Mangold, J. (Director). (1999). Girl, Interrupted. Web.

Videler, A. C., Hutsebaut, J., Schulkens, J. E., Sobczak, S., & Alphen, S.P. (2019). A life span perspective on borderline personality disorder. Current Psychiatry Reports, 21(51), 119-128.

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PsychologyWriting. ""Girl, Interrupted": Mental Illness Analysis." September 18, 2023. https://psychologywriting.com/girl-interrupted-mental-illness-analysis/.