McLean Hospital

Susanna Kaysen is an eighteen-year-old girl who has been sent to McLean Hospital to be treated for depression, and spends two years on the ward for teenage girls in the psychiatric hospital. Susanna’s behaviour in the ward varies drastically from considerably normal to severely abnormal when she associates and befriends Lisa Rowe. The ‘medical’ criterion of normality suggests that normality is the absence of any medical or mental disorder while Abnormality is the presence of an illness that has a clear cause, obvious symptoms and a label. I chose this criterion to define Susanna’s behaviour, because I think it is necessary to look at the medical side of her behaviour.

Therefore according to this criterion of normality, Susanna is most certainly abnormal. She has a labeled mental illness and has obvious symptoms which accompany this label. These symptoms include her behaviour, which is dramatic and selfish and her mental incapability to function and cope with the demands of daily life. She falls asleep at her Graduation ceremony, uses casual sex as a distraction from her problems, carries out self-mutilating behaviour such as wrist banging, thinks and talks about death and suicide often and has visions of the past, tuning out when people try to talk to her. However the problem with using this criterion to define normality is the fact that some individuals may seem like they don’t have an illness but when examined more carefully it is seen that they have a minor illness which does not affect them as much.

This would challenge the way the medical criterion defines normality as even though the individual has an illness it is not a dramatic one. Another criterion that I chose was the situational criterion as it gives a different approach to what normality is. The ‘situational’ criterion of normality suggests that what is normal is dependent on the specific environment or situation the individual is in. Therefore according to this approach, Susanna is considerably normal when in the psychiatric hospital but abnormal when in the outside world. In the psychiatric hospital she is surrounded by individuals with mental illnesses and therefore it becomes appropriate for her to act the way she does.

It is normal behaviour to have casual sex, treat others with no respect and have feelings of emptiness and depression and act in a way you would not usually act in. When the nurse throws Susanna into the bathtub with her clothes on Susanna loses her temper and starts screaming and demanding the nurse to take her out of the tub. This behaviour is considered normal by the situational approach as she is in an environment that allows this kind of behaviour.

But although this may be normal in the psychiatric hospital it is most definitely abnormal in the outside world. If Susanna were to do this at her house and treat her mother in this way she would be sent to her room or maybe even sent to see a councilor to discuss her problems. A problem with this approach though, is that it does not take into consideration how normal the actual environment is in the first place. For example a psychiatric hospital is considered an abnormal environment but yet people in this hospital are considered normal by the situational criterion because they are acting in accordance with the environment they have been placed in.

A possible disorder that Susanna may have is ‘Borderline Personality Disorder’. The symptoms which support this diagnosis are her theatrical behaviour and uncertain personality. Susanna carries out self-mutilating behaviour such as wrist banging, falls asleep at her Graduation ceremony, uses casual sex as a distraction from her problems, thinks and talks about death and suicide often, has visions of the past, tuning out when people try to talk to her, has drastic mood swings, has uncertainties about her self-image and becomes intensely angry when things don’t go her way. The situational factors that may have contributed to the development of her illness may have been the pressure she was receiving from her school teachers and classmates to go to college and the pressure she was receiving from her parents, specifically her mother, to be the perfect daughter.

Susanna would hear about her classmates wanting to be lawyers, ethno botanists and doctors and would feel sadness as she thought because she didn’t want any of this she would have nothing or be shut out of life. The pressure of being the first person in the history of her school not to go to college also didn’t help the situation. Susanna also thought she was crazy which may have made her condition worse. All these pressures may have been factors that contributed to the development of her illness. Other information that may assist in reaching a diagnosis is Susanna’s parent’s medical history, information about Susanna’s childhood and her hobbies or interests if she had any.

Susanna has been institutionalized because she is thought to have a mental disorder by the name of ‘Borderline Personality Disorder’. She does not behave appropriately or is able to cope with daily life and has feelings of emptiness and depression and thinks about death and suicide often. Susanna has been sent to a psychiatric hospital in hope that she may be cured and freed from these feelings. I believe that to a certain extent, being institutionalized has been beneficial to Susanna. By being institutionalized Susanna got to meet and interact with patients that had far more severe mental conditions than her own and realize that she didn’t want to sink that deep. By seeing this way of life and spilling her thoughts into her diary and to her therapist she was able to overcome her disorder and recover.

But although this may have helped her, being institutionalized also made her disorder worse in a way. At the start because she was surrounded by mental patients she found it easier just to act out the disorder she had been labeled making her physical health worse. I think she would have recovered much earlier if she had just been seeing a therapist a couple of times a week, writing in her diary and became relieved of all the pressure from her parents and teachers.

Labeling influences the behaviour of individuals and those around them quite drastically. When an individual is labeled with a certain disorder they begin to use the label to their advantage to get away with as many things as they can and get as much special treatment as they can. The people around them begin to either tread more carefully around the individual who has been labeled or begin to act the same as them to fit in. This may affect my diagnosis as when Susanna was labeled with a ‘Borderline Personality Disorder’ she may have just started acting like she had the disorder rather than actually truly having a mental illness.

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