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Girl Interrupted
By Susanna Kaysen. New York: Vintage Books, 1993, 168 pp., $11.00 (paper).
Girl Interrupted, by Susana Kaysen, discusses a young woman's experience with mental illness during the late 1960's. This first hand account of a young woman's struggle with her diagnosis of a borderline personality disorder, subsequent hospitalization and treatment, provides a realistic conceptualization of what it means to have a borderline personality. This book focuses not only on Kaysen's individual struggle and growth, but on the stigma society attaches to mental illness and the frustrations of treatment. For many individuals who are struggling with their own diagnosis of mental illness and the treatment they must go through, this book may serve as an informative and supportive resource when used for bibliotherapy.
The book is structured with short, concise chapters that do not follow chronological order but are instead organized into a narrative that places important events, details and facts first, other relevant events and details second. The chapters are two to five pages in length and the title of each chapter describes the piece of that narrative that it contains. Interwoven with the narrative chapters are copies of Kaysen's progress notes and other paperwork from her stay at the psychiatric hospital as well as an excerpt from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised which lists the criteria for Kaysen's diagnosis. Kaysen completes one topic in each chapter, keeping events out of the order in which they occurred, although she does begin the book with why she was brought into the hospital and ends with how her perception of that has changed. The illogical order is the logical way for Kaysen to present her topic since it is reflective of how she felt during her hospitalization and sets an important tone for the book. Kaysen shares her experience not only of hospitalization but of psychiatric medication, psychoanalysis, hallucinations, delusions, suicide and other patients she interacts with. With this structure, Kaysen tries to present understanding from the perspective of someone well experienced in the realm of mental illness as a patient rather than a physician or psychotherapist.
Girl Interrupted is an appropriate bibliotherapy tool for adults of any age with at least high school education but may be best for young adult females due to the style and level at which it is written. As the title suggests, it is the story of a young woman dealing with her mental health difficulties and it may be easier for other females to relate to what the author is sharing. However, the experience of a diagnosis of mental illness, the disruption and confusion associated with a break from reality, and the process of treatment are universal and make the book relevant to any individual, male or female, who may be struggling with these issues. The book may be most relevant to individuals with personality disorders, specifically borderline, but could be useful to any relatively high functioning person with mental illness who feels confused or alone in their struggle. In addition to individuals struggling with mental illness first hand, Kaysen's book may be beneficial to family members, friends, co-workers or anyone close to an individual with a mental illness. For people who are not mentally ill themselves but are supportive of someone who is, Girl Interrupted will provide them with a detailed description of what it is like to live with a mental illness.
Kaysen's book is not appropriate for children, low functioning individuals, or people with less than a high school education. The book is written at a somewhat advanced level, with references and language that people without high school education may have difficulty understanding. Children may lack not only the education, but the abstract reasoning abilities to relate Kaysen's account to their own situations. Kaysen's book may be restricted to use in western culture since she is American and her experience with mental illness reflects the American philosophy of psychiatric treatment. Overall, Girl Interrupted would be more helpful to adults who have high enough intelligence and motivation to process this kind of narrative and relate it to their own situations.
Kaysen's book has several strengths as a tool for bibliotherapy. Girl Interrupted presents the personal account of someone who has been through treatment for mental illness and thus can provide support for someone beginning psychotherapy. Kaysen makes clear in her narrative her displeasure with being "locked up" and being labeled as "nuts." To clients reading this apparently jaded account, it may be helpful for them to have validation for their own feelings of resentment towards their diagnosis and possibly, if applicable, their hospitalization. The book also provides clarification on the idea that people who are mentally ill never recover. Kaysen clearly proves that recovery is possible and describes how that happened for her providing the instillation of hope for the reader.
Although this book is an asset in bibliotherapy overall, there are some limitations as well. Kaysen's book provides a very specific personal account, which may be hard for some individuals to follow in order to relate the idea of her story their own experience. Also, since Kaysen is describing hospitalization and treatment from her young adulthood, that occurred thirty years ago, there are differences and changes in what a reader in treatment or a hospital may be experiencing today. These limitations are not major and will likely not interfere if the psychotherapist is selective in whose therapy the book is used and how it is incorporated.
While being aware of the assets and limitations of Girl Interrupted, it can be used in psychotherapy several ways. The psychotherapist could use the book as a comparison to what the client is experiencing currently or has experienced in the past by having the client read sections and then discuss them in psychotherapy sessions. The client may then be able to feel as if someone identifies with him or her and will then be more willing to commit to treatment. This insight may help them to progress to an active readiness for change. The psychotherapist may want to make reading assignments at the conclusion of each session in order to have the readings follow what is being discussed in psychotherapy so the comparison to the client's life is more relevant. If the psychotherapist structures incorporation of the book in this more guided way, he or she will be able to apply only the most relevant chapters rather than assigning the entire book.
The different ways of utilizing Girl Interrupted in psychotherapy can help clients work toward several different types of goals. One treatment goal may be for clients to conceptualize what precipitated their illness. Another goal of treatment use of Kaysen's book might help clients reach is to determine how they can manage their mental illness and have a satisfying life. Girl Interrupted may also help clients to identify feelings about their illness and treatment. Goals may be tailored to the needs of each client at the discretion of the client and psychotherapist.
In sum, Girl Interrupted can be a beneficial bibliotherapy tool to a client who is coming to terms with mental illness and is at an appropriate age level. The book can be used as part of the psychotherapy process very effectively. The therapeutic benefit that can be derived from Kaysen's book has great potential if the client has the motivation to work toward achieving treatment goals and gaining insight. By providing her own personal experience, Kaysen helps clients to realize how their own illness can be worked through and managed so that they can live a fulfilling life.