Girl, Interrupted (1999): Exploring Four Mental Disorders Case Study

Introduction

Directed by James Mangold, Girl Interrupted is a thrilling movie about a sixteen-year-old Susanna Kaysen who suffers from borderline personality disorder. On April 1967, Susanna checks into Claymoore Hospital, a psychiatric hospital in Belmont, Massachusetts. In the hospital she finds other patients, befriends them and they make her stay there eventful. As the film opens up, Susanna tries to commit suicide; fortunately, she fails.

Among the friends cum patients, that Susanna finds in this hospital is Daisy, Lisa Cody, Cynthia, Georgina, Lisa, and Polly. Apart from the dramatic and the entertaining aspect of this movie, it contains a psychological aspect and this is the major purpose of this paper; exploring the psychological disorders in the movie, giving their causes and treatment.

As aforementioned, Susanna’s friends are patients in this hospital and each suffers from a different psychological disorder. Starting with Susanna, she suffers from borderline personality disorder; Lisa is a sociopath; Polly is schizophrenic; Georgina is depressed while Daisy suffers from obsessive-compulsive disorder. This paper explores four mental disorders viz. borderline personality disorder, Schizophrenia, obsessive compulsion disorder and major depressive disorder.

Borderline Personality Disorder (BPD)

BPD is a “prolonged disturbance of personality function in a person (generally over the age of eighteen years, although it is also found in adolescents), characterized by depth and variability of moods” (Millon, 1996, p. 645). Symptoms of BPD include, mood swings, poor interpersonal relationships, low self-esteem, and in severe cases, it leads to disassociation.

Consequently, victims of this disorder face challenges in maintaining any meaningful relationship whether at home, workplace, school, or any other social setting. There have been calls from different quarters to change the name from BPD to Emotionally Unstable Personality Disorder (EUPD); however, these calls are still ungratified so BPD remains.

Etiology of Borderline Personality Disorder (BPD)

Just like many other psychological disorders, BPD has no explicitly known causes; however, researchers and psychologists have come up with postulations that correlate strongly with BPD. These causes include environmental and neurobiological factors, genetic predisposition, and brain abnormalities.

Childhood abuse tops the list of probable BPD causes. There are sufficient studies that link childhood abuse to BPD especially sexual abuse. Majority of individuals suffering from BPD have a history of childhood abuse. Studies show that, these people experienced emotional, physical, verbal, or sexual abuse from either their parents or caregivers.

Child neglect also comes in as it plays the same role as abuse and many victims confess experiencing neglect in their childhood. Other studies show that BPD may be biologically linked and Millon (1996) posits that, “BPD may not necessarily be a trauma-spectrum disorder and that it is biologically distinct from the post-traumatic stress disorder that could be a precursor” (p. 660).

A study carried on identical twins showed that if one of them has BPD, then the other has a 35% probability of having the same disorder, this insinuates the probability that BPD may be genetically linked. Moreover, some of behaviors expressed by BPD patients relate closely to those of serotonin function and regulation and this links this disorder to neurofunction.

Treatment of Borderline Personality Disorder (BPD)

Apart from psychotherapeutic practices that are under development, there is no known cure of BPD; it is even advisable not to attempt treating it. However, in cases of co-morbid situations, psychologists use antipsychotics, antidepressants, and mood stabilizers, to treat this disorder.

Schizophrenia

Schizophrenia is a psychological disorder, “characterized by abnormalities in the perception or expression of reality” (American Psychiatric Association, 2000). The common symptoms of schizophrenia include delusions, hallucinations, uncoordinated speech, and paranoia among others. This disorder is prevalent amongst young adults. Unfortunately, there are no known laboratory tests of this disorder and diagnosis is based on one’s behavior.

Etiology of Schizophrenia

There is sufficient evidence to conclude that, environmental stressors in concert with genetic factors are probable causes of schizophrenia. According to Owen, Craddock, and O’Donovan (2005), “schizophrenia is a condition of complex inheritance with many different potential genes; each of small effect, with different pathways for different individuals” (p. 520).

Research indicates that some chromosomal regions increase the risk of developing schizophrenia. For instance, “Chromosome 6 HLA region interacts directly with the Disrupted in Schizophrenia 1 (DISC1) gene protein more recently the zinc finger protein 804A” (Hennah, Thomson & Bass, 2009, p. 865). This association increases schizophrenia cases.

On the other side, social factors play crucial role in development of schizophrenia. For instance, studies indicate that, people living in urban areas stand a great chance of becoming schizophrenic. Moreover, people exposed to social disadvantages like poverty, discrimination, adversity, and unemployment risk becoming schizophrenic.

Finally, substance abuse links strongly to schizophrenia. A ten-year study carried out to establish the relationship between schizophrenia and recovery from drug abuse indicated that, “substantial proportions were above cutoffs selected by dual diagnosis clients as indicators of recovery” (Ferdinand, Sondeijker & Verhaust, 2005, 619). Commonly abused drugs that could lead to this disorder are cocaine and methamphetamine.

Treatment of Schizophrenia

According to Kay, Fiszbein and Opler (1997) the commonly used method of Schizophrenia management is Positive and Negative Syndrome Scale (PANSS) (p. 269). PANSS manages schizophrenia better than treating it. On the other hand, the widely accepted treatment method is antipsychotic treatment. These drugs take as few as 7 days to reduce psychosis; unfortunately, most of the times the results are not satisfactory.

Nevertheless, atypical antipsychotic drugs function better compared to traditional typical ones that register high failure rates. These atypical drugs include quetiapine, olanzapine, risperidone, perphenazine, and ziprasidone; however, perphenazine functions best taking about eighteen months to complete the dose. There are also some psychotherapeutic interventions dealing with issues like improving self-esteem, and other personal development strategies to boost one’s confidence.

Major Depressive Disorder

Also known as, unipolar disorder, Major Disorder is a psychological disorder “characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities” (Hays, Wells & Sherbourne, 1995, p. 15).

This is an advanced state of depression, which affects severely one’s life, running from relationships and work life, through education to sleeping habits. In severe cases, people commit suicide. Diagnosis entails profiling one’s behavior over a period to establish the severity of the disorder because there are no known laboratory tests for the same.

Etiology of Major Depressive Disorder

Research work indicates that depression may result from social, psychological, and/or biological factors. Biologically, depression may result when “low serotonin levels promote low levels of nor-epinephrine, another monoamine neurotransmitter” (Shah, Eisner, Farrell & Raeder, 1999, p. 37).

Under such cases, people experience mood swings and they lose happiness and energy leaving a depressed individual. Other neurotransmitters linked to depression include dopamine; its reduction leads to decreased attention, pleasure, and motivation levels.

Psychologically, negative emotionality leading to low self-esteem has been identified as a common cause of depression. In most cases, people would become depressed under given circumstances; however, while this is common, the way individuals handle these situations determine whether they will succumb to major depressive disorder or not. This aspect links this case to one’s emotionality; if it is negative coupled with low self-esteem; then someone slumps into major depression disorder.

Social factors like poverty, isolation, and discrimination among others lead to depression. Any form of abuse, especially at tender age may have long-lasting depression effects on an individual. In adulthood, people face tough situations and if they are not strong enough, series of depressive episodes culminate to major depression disorder.

Substance abuse also contributes largely to development of major depression disorder. Common hypnotic drugs like benzodiazepines and alcohol increases the risk of becoming depressed. Addiction precedes depression and as individuals struggle to quit addiction, they suffer from withdrawal symptoms and if not properly managed, this stage may lead to depression.

Treatment of Major Depressive Disorder

Antidepressants function better than any other form of depression management. Commonly used antidepressants are, escitalopram, sertraline fluoxetine, citalopram, and paroxetine. However, bupropion and venlafaxine are the newest and atypical antidepressants with high effectiveness. On the other side, psychotherapy is used as a management strategy; however, as aforementioned, it is not as effective as antidepressants.

Obsessive–Compulsive Disorder (OCD)

OCD is a psychological disorder characterized by, “intrusive thoughts that produce anxiety, by repetitive behaviors aimed at reducing anxiety, or by combinations of such thoughts (obsessions) and behaviors (compulsions)” (Null, 2006, 269). Common symptoms include aggressive impulses, insistent hand washing, upholding weird beliefs, fear of some odd numbers like number thirteen, and funny behaviors like opening and closing windows several times to ensure that they are closed.

Most of these behaviors are tiresome and time-consuming, leading to weariness and emotional loss. Interestingly, OCD victims realize their behaviors and actions are irrational; however, they find it hard to overcome them. This may lead to depression; another psychological disorder which complicates the condition further.

Etiology of Obsessive–Compulsive Disorder (OCD)

It is evident that both biological and psychological factors contribute to this disorder; however, researchers do not agree on the intensity at which a factor can lead to OCD. Until Sigmund Freud came to psychological scenes, OCD victims were thought to be ‘possessed’ by evil spirits.

However, Sigmund established that, “this is a typical case of ‘touching phobia’ as starting in early childhood, when the person has a strong desire to touch an item. In response, the person develops an ‘external prohibition’ against this type of touching.

However, this ‘prohibition does not succeed in abolishing’ the desire to touch; all it can do is repress the desire and force it into the unconscious” (Freud, 1950, p. 16). These thoughts crowd one’s mind, infiltrate the subconscious mind, and are exhibited as fears.

Biologically, studies link OCD to serotonin, which regulates anxiety. Postulations have is that, in OCD victims, serotonin receptors are under stimulated and this is supported by the fact that, OCD patients respond well to selective serotonin reuptake inhibitors (SSRIs). The genetic aspect of OCD correlates with the biological aspect because recent research indicate that OCD victims have a DNA mutation in serotonin transporter gene and this insinuates a probability of OCD being genetically linked.

Treatment of Obsessive–Compulsive Disorder (OCD)

Medication of OCD involves use of SSRIs like fluvoxamine, fluoxetine escitalopram paroxetine, and sertraline. Antidepressants like clomipramine can also be used in place of SSRIs. There are alternative drug treatments including use of inositol, a naturally occurring sugar.

Balanced diet containing vitamin supplements helps a lot in OCD treatment. As a last resort, patients may opt for psychosurgery, which involves “making a surgical lesion in an area of the brain (the cingulate cortex) through deep-brain stimulation and vagus nerve stimulation which do not require destruction of brain tissue” (Barlow & Durand, 2006, p. 96).

Conclusion

Girl Interrupted is a film based on Susanna Kaysen’s memoir, profiling personal experiences in a psychiatric hospital. In hospital, Susanna meets other patients suffering from psychological disorders. Four mental disorders stand out clearly in this film viz. borderline personality disorder, schizophrenia, major depression disorder and obsessive-compulsive disorder.

These disorders tie closely for they affect the same area, brain. BPD affects mainly adults characterized by varied moods and it affects personal relationships greatly. Even though there are no explicit known causes of this disorder, researchers postulate that it may be caused by psychological, biological, or genetic factors.

Treatment is not advisable even though in cases of co-morbid cases antidepressants may be used. Schizophrenia affects the way an individual understands reality and it leads to hallucinations and delusions among others. Environmental stressors function in concert with genetic factors to cause this disorder. PANSS is the commonly used treatment method in schizophrenia management. Major depressive disorder is an advanced depression leading to severe low self-esteem and withdrawal.

Researchers hypothesize that social, biological, and psychological factors contribute to development of the same. Finally, OCD sufferers have compulsions and obsessions and this may be tied to both psychological and biological factors. All these mental disorders have no known laboratory tests and diagnosis is based on behavioral observation.

References List

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Barlow, D., & Durand, M. (2006). Essentials of Abnormal Psychology. California: Thomson Wadsworth.

Ferdinand, R., Sondeijker, F., & Verhulst, C. (2005). Cannabis Use Predicts Future Psychotic Symptoms, and Vice Versa.” Addiction, 100 (5): 612–8.

Freud, S. (1950). Totem and Taboo: Some Points of Agreement between the Mental Lives of Savages and Neurotics. New York: W. W. Norton & Company.

Hays, R., Wells, K., & Sherbourne, C. (1995). Functioning and Well-Being Outcomes Of Patients with Depression Compared With Chronic General Medical Illnesses” Archives Of General Psychiatry, 52 (1): 11–19.

Hennah, W., Thomson, S., & Bass, N. (2009). DISC1 Association, Heterogeneity, and Interplay In Schizophrenia and Bipolar Disorder. Mol Psychiatry 14 (9): 865–73.

Kay, S., Fiszbein, A., Opler, L. (1997). The Positive and Negative Syndrome Scale (PANSS) For Schizophrenia. Schizophr Bull 13 (2): 261–76.

Millon, T. (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: John Wiley and Sons.

Null, G. (2006). Obsessive–Compulsive Disorder. Get Healthy Now. Seven Stories Press.

Owen, M., Craddock, N., & O’Donovan, M. (2005). Schizophrenia: Genes at Last? Trends In Genetics 21 (9): 518–25

Shah, N., Eisner, T., Farrell, M., & Raeder, C. (1999). An Overview Of SSRIs For The Treatment of Depression. Journal of the Pharmacy Society of Wisconsin. 32(4): 36-43. Web.