Welcome back to Analyze Scripts, where a psychiatrist and a therapist analyze what Hollywood gets right and wrong about mental health. Today, we are analyzing the '90s movie "Girl, Interrupted" based on the memoir by Susanna Kaysen. This film depicts two years of a young adult woman's life at McLean Hospital in the 1960s where she was diagnosed with borderline personality disorder (BPD). This episode analyzes everything from why it's so hard to talk about BPD, psychoanalytic vs behavioral treatment methods, the deinstitutionalization movement, antipsychotics, and our opinions about Angelina Jolie's portrayal of sociopathy. We hope you enjoy!
[00:10] Dr. Katrina Furey: Hi, I'm Dr. Katrina Fieri, a psychiatrist.
[00:12] Portia Pendleton, LCSW: And I'm Portia Pendleton, a licensed clinical social worker.
[00:16] Dr. Katrina Furey: And this is Analyze Scripts, a podcast where two shrinks analyze the depiction of mental health in movies and TV shows.
[00:23] Portia Pendleton, LCSW: Our hope is that you learn some legit info about mental health while feeling like you're chatting with your girlfriends.
[00:28] Dr. Katrina Furey: There is so much misinformation out there and it drives us nuts.
[00:32] Portia Pendleton, LCSW: And if someday we pay off our student loans or land a sponsorship, like.
[00:36] Dr. Katrina Furey: With a lay flat airline or a major beauty brand, even better.
[00:39] Portia Pendleton, LCSW: So sit back, relax, grab some popcorn.
[00:42] Dr. Katrina Furey: And your DSM Five and enjoy. We get started with this episode. We just wanted to add a trigger warning. Some of this content could be disturbing to listen to. We're talking about the film Girl Interrupted, and there are some themes of suicide, disordered eating, and I would say institutional traumatization. So again, if any of these themes hit too close to home or could potentially be damaging, please feel free to skip this episode and join us again next time. Otherwise, enjoy. Hi, thanks for joining us. Today we are going to talk about the hit movie Girl Interrupted. A real blast from the past from my favorite decade, the 90s. This movie is based on the 1993 memoir by Susannah Casey, who wrote about two years of her life spent at McClain Hospital in the 1960s in Massachusetts, where she was diagnosed with borderline personality disorder. Portia so when I recommended we covered this movie, I totally didn't remember the plot. I don't actually know if I saw the whole thing. I was just like, oh yeah, there's a movie with Angelina Jolie and she got an Oscar and it's probably really good. I totally forgot that the main character was diagnosed with Bpd, which I actually think is great for us to talk about because we've alluded to this diagnosis and some of our other know, I'm thinking like, what about Bob Succession White Lotus? And I still find that this is a tricky diagnosis to talk about with patients to explain to patients to explain to other. I thought, you know, Winona Ryder's character like, did a great job being like, what is it? On the borderline of what? What are you talking about? Right?
[02:38] Portia Pendleton, LCSW: Yeah. And at the time, though, this was newish. Marsha Linehan hadn't written her book yet on DBT.
[02:47] Dr. Katrina Furey: I don't even think there was DBT yet. Thinking about the 1960s, I thought this film did a great job depicting what it probably was like to be psychiatrically hospitalized in the 60s, which is so different from what it's like today. Place that is very true. So this film was filmed at Harrisburg State Hospital in Harrisburg, Pennsylvania. It was filmed in 1999, but it was based on McLean Hospital, which is probably the number one psychiatric hospital in our country for a long time. I think it is affiliated with Harvard, and I think they do still have some longer term units like this, but you see a lot of treatment. You know, she goes to therapy many times a week. She's sitting on the couch. Her therapist is sitting behind her. Unfortunately falls asleep at one point, which I don't think actually happens in real life, but speaks to how she felt probably like there was a disconnect and you hear about how she's there for two years. That just doesn't happen anymore. But in the did, that was the treatment. People used to be admitted and stay for a really long time until in the mid 1960s, in the Reagan era, there was this big move not just in our country but internationally to deinstitutionalize patients, right? So sort of close down these long term hospitals which we called asylums and invest more in community mental health centers. And I think I don't know this for sure, but I believe that coincided with the invention of modern day antipsychotic medication like Thorazine and the other medications that came from that, like Haldol, basically medications that could treat schizophrenia and thereby treat these patients in a way that hopefully they didn't have to live in an institution. Sadly, we haven't invested enough in the community mental health centers that were supposed to be created to sort of support patients and we've had some really awful side effects from that. Primarily homelessness and institutionalization in jails. That is the number one provider of mental health treatment in our country. How awful and disgusting is that? And again, it's because not enough money goes into these community mental health centers. So nowadays you might be admitted for a couple of days to really stabilize you, tweak your meds, but you're not getting this type of intensive, insight oriented therapy anymore that we see depicted in this movie. And I think that's really sad. You can get that if you can pay for.
[05:29] Portia Pendleton, LCSW: I mean, it's wildly expensive.
[05:31] Dr. Katrina Furey: Wildly expensive. And I think some places, like other, you know, hospitals might take insurance. I don't know if insurance would cover it.
[05:41] Portia Pendleton, LCSW: Yeah, they take some and especially for some programs. Like, I've had some people go to McLean, I've known some people to go to Silver Hills. Those two places over the years have definitely taken more of an insurance route for some of their programming and other tracks that they have. Other parts of their residences or programs are not insurance based.
[06:03] Dr. Katrina Furey: And I think that also just speaks.
[06:04] Portia Pendleton, LCSW: To like there's not a lot of people who can afford to be somewhere for a year and pay that. So I think they've also just had to do that where it's like some of their income is insurance based and others they are able to get private pay.
[06:19] Dr. Katrina Furey: And I would like to think that they would take insurance for more situations if insurance would freaking pay, right? But insurance is the worst. That's a whole nother tangent for another day. But they don't pay. They don't even pay know, short just it's really an abomination. Yeah. So anyway, getting back to the movie, we have an all star cast. So Winona Ryder is playing Susanna, the main character. We have Angelina Jolie playing Lisa, the woman with sociopathy. She won an Academy Award for this role. I think Winona Ryder did too. Or maybe she was nominated. I can't remember. We have Whoopi Goldberg playing Valerie, the nurse. Elizabeth Moss playing Polly, the girl who was a burned victim from childhood. Clea duvall is played. Georgina susanna's roommate.
[07:12] Portia Pendleton, LCSW: And she is in the show Veep.
[07:14] Dr. Katrina Furey: That I really love. I haven't seen it before, but I've heard really good.
[07:17] Portia Pendleton, LCSW: I was like, oh, my gosh. Oh, my gosh, it's her. Yeah, I couldn't believe it.
[07:21] Dr. Katrina Furey: And then we had Brittany Murphy, who played Daisy. Who. That's just a tragic death and weird circumstances on its own. But I loved her, and I loved her roles in the then we had Jared Leto, who knew? Playing Toby.
[07:36] Portia Pendleton, LCSW: I was like, who? Before I looked at the cast list, I was like, who is that? Why does he look so familiar? I couldn't believe it. So young.
[07:43] Dr. Katrina Furey: I know.
[07:43] Portia Pendleton, LCSW: Like a baby.
[07:44] Dr. Katrina Furey: They all look so young. And then we have Jeffrey Tambor playing Dr. Melvin Potts, her first psychiatrist. And then we see Vanessa Redgrave playing Dr. Wick, the female psychiatrist. And there's a lot of other characters too, but those are just some of the main heavy hitters.
[08:01] Portia Pendleton, LCSW: Yeah.
[08:02] Dr. Katrina Furey: So what did you think, Portia, about the opening?
[08:07] Portia Pendleton, LCSW: A little confusing. I mean, I was like, Is this present know? And then I was confused because it starts with her in the hospital, right, getting her stomach pumped.
[08:16] Dr. Katrina Furey: Then I think the very first thing is you see, like, a broken light bulb in a syringe, and the girl's like, in the psych hospital, and you're like, what's going on? And then it flashes.
[08:24] Portia Pendleton, LCSW: So then she wakes up.
[08:26] Dr. Katrina Furey: And I was like, okay.
[08:27] Portia Pendleton, LCSW: So was that a flashback? Was that a memory? Is her stomach getting pumped real? I was confused with those two first scenes.
[08:36] Dr. Katrina Furey: Yeah, totally. And I wonder I would imagine that was kind of intentional. And then we see her being pretty aggressively restrained. We see the tube down her throat, I think, pumping her stomach. And my first thought was, what did she overdose on? This looks like they're trying to treat her for an overdose. And then someone screams out, oh, she's a wristbanger. I was like, what does that mean? And she said something about, there's no bones in my hand. And I was like, what is going on here? But I think it did give a pretty good snapshot into her mental state at that point in time. I was like, okay, she's overdosed on something that's dangerous enough where they have to aggressively pump her stomach. Now, we can't wait. We have to hold her down before we even get a sedative in her. Maybe back then they didn't even really have sedatives. Honestly, I'm not sure when things like Adivan and stuff were invented. And that thing about not having bones in her hand made me think, is she psychotic? Is she not? What's going on? Then we see her lock eyes with that man in the hallway, who we later learn is, like, her dad's colleague who's married, and she's had some sort of sexual relationship with him. And then she's pretty quickly seeing a psychiatrist in his home. You see her looking out the door, seeing his family and looking out the window and seeing her mom unpacking a suitcase. And I was like, Uhoh, yeah.
[10:04] Portia Pendleton, LCSW: And still does happen. But I think it was more common in the past with these kind of, like, voluntary, but involuntary getting someone to treatment. Right. So it's like, whether you're an adolescent, and it's not voluntary at all, and your parents are taking you there, so it's under their voluntary, but not telling them where they're going. So, hey, we're going to go for a car ride. They don't know their suitcases packed, and then we're taking you to treatment. Or the horror stories of those wilderness camps where you're, like, abducted in the middle of the night. I was kind of thinking of that with Susanna being an adult. Right. It's like, in my head, I'm like, at any time, she can kind of.
[10:40] Dr. Katrina Furey: Back out of this. Well, can she? It turns out she couldn't. Right.
[10:45] Portia Pendleton, LCSW: That was also my question was, why.
[10:47] Dr. Katrina Furey: Was it different in the so I don't know the full rules, but I do know that a lot of things they depicted in terms of getting her to the hospital don't happen these days. So she's seeing this psychiatrist. So an old white man, by the way, and he doesn't do this anymore. He very readily volunteers that way to instill confidence in your patient. I thought he was very shaming. I didn't like the way he spoke to her. He was not connecting with her. It was very clear she was, like, a bother to him in that the way he was saying, like, I'm just doing this as a favor to your dad. Why are you doing this to everyone around you? I just thought it was awful. What a terrible way to treat someone who is just clearly attempted suicide, even if she's saying, I always just had a headache. I didn't mean to take that much. It's clear what was going on. And then he just puts her in a cab and trusts the cab driver to take her to the psychiatric hospital. Okay. Yeah. Okay.
[11:49] Portia Pendleton, LCSW: That's his responsibility.
[11:50] Dr. Katrina Furey: We 100% don't do that. If you need to send someone to the psychiatric hospital, hopefully you can talk with them and talk with their family and come up with a plan where they're on board. That's the ideal way, right, to sort of have their family bring them, and they're voluntarily seeking help. Sometimes people aren't willing to go and they need to go for their safety. And that's when, at least in the state of Connecticut, a psychiatrist can involuntarily hospitalize someone by signing what's called the Physician's Emergency Certificate or a PEC form. There's only two conditions in our state where you can basically take away someone's civil liberties by saying you have to be institutionalized against your will. That would be if you are an imminent threat to yourself or someone else. So in terms of like suicidality or homicidal threats or if you are so gravely disabled from your mental illness that there is fear of your being able to survive without immediate intervention. So people who unfortunately have something like a psychotic disorder, who aren't eating, who are harming themselves in some way but might not realize it like if they have diabetes and aren't taking their insulin, things like that. But it has to be really severe in order for you to be able to check that box. You can't check it for things like substance abuse. That's a different type of involuntary commitment and that one's really hard to get.
[13:12] Portia Pendleton, LCSW: You can also send people involuntarily to the hospital just for the eval. You know what I mean? Like cops can do that.
[13:20] Dr. Katrina Furey: You're right. Sometimes people will voluntarily sign themselves in. Once you do that, though, you can't voluntarily sign yourself out. Usually the team does have to kind of be in agreement that you're ready to leave. If not, then they could petition the courts to then involuntarily commit you to sort of see out your treatment. But it's not like, for two years anymore.
[13:44] Portia Pendleton, LCSW: Yeah. So we learn later in the movie. But that Lisa has been there for eight years.
[13:49] Dr. Katrina Furey: Not surprising, right, given her personality pathology. And it seems like she frequently elopes, which is the fancy word to say.
[13:59] Portia Pendleton, LCSW: You know, my question was just thinking about is she making herself known? Is she kind of coming back? Is she presenting in a hospital somewhere? Like, how are they finding her?
[14:08] Dr. Katrina Furey: Right. Are they finding her or is she finding them? Does she have some sort of tie of dependency to the institution that's been taking care of her? Because it seems like she's like the leader in some ways. Right. And I thought that I mean, what were your thoughts, Portia, of Angelina Jolie's depiction of Lisa with antisocial personality disorder?
[14:27] Portia Pendleton, LCSW: I thought it was good because you can see how those people can kind of suck others in yes.
[14:35] Dr. Katrina Furey: That charming.
[14:37] Portia Pendleton, LCSW: And appear really interesting and powerful and fun and light and it's almost like they know what you need. So she was all these things to different people.
[14:49] Dr. Katrina Furey: Yes. And then knows also how to get under people's skin. Like we see with Daisy in a really sinister way.
[14:57] Portia Pendleton, LCSW: Oh, yeah. Like horrific. I mean, I didn't really, I guess, get the flair of oh, my. Like, I really don't like her. She's horrible. Until that moment.
[15:09] Dr. Katrina Furey: Yeah. Right.
[15:10] Portia Pendleton, LCSW: Until the because she doesn't let it go. It wasn't just like, oh, I kind of threw this out there. Maybe someone may do that. I'm thinking maybe who has, like, a borderline personality disorder. They're kind of pushing the limits a little bit, but take it that far is not typical, right?
[15:26] Dr. Katrina Furey: And I thought at first in seeing her on the screen, I thought she was depicting Bpd because she comes in very provocative. You can tell, like, the staff is all up in arms, right? Like, Nurse Valerie, played by Whoopi Goldberg, I think is helping Susanna settle in and then gets some kind of someone comes in, like, whispers in her ear, like and then you see all the staff is ah. Some of the patients there get really nervous, but then some of them are excited to see her again. I think that actually displayed the concept of splitting really well. That these types of patients tend to rile people up. And some people are on the good side, some are on the bad side. And then you pit them against each other.
[16:05] Portia Pendleton, LCSW: Really manipulative.
[16:06] Dr. Katrina Furey: Really manipulative. And so at first, I thought that was the type of character she was portraying until the movie went on. And you'd see her get under people's skin and then not let go. And you could sense she got off on that. Even in the rolling chair when she steals the nurse's pen and has it at her throat with that sort of suicidal gesture. You got the sense they've done this before. You knew that this nurse had opened.
[16:32] Portia Pendleton, LCSW: Up to her, which huge red flag.
[16:37] Dr. Katrina Furey: Don't do that.
[16:37] Portia Pendleton, LCSW: And also, though, it's like that is most likely to happen with that kind of a patient, 100%. They're really good at getting under your.
[16:45] Dr. Katrina Furey: Skin and getting you to open up to feel safe and comfortable. This is how serial killers abduct people. This is how it happens. So I thought she did an amazing job portraying both sides of that. Like, both the charming, fun, playful nature that attracts people and then that sinister, manipulative, sadistic side.
[17:07] Portia Pendleton, LCSW: I mean, not being impacted by Daisy's death. So, like, Susanna is very appropriate reaction. And again, I'm saying this like, ha ha. But even someone with a personality disorder.
[17:23] Dr. Katrina Furey: It'S like, yeah, because she has appropriate.
[17:25] Portia Pendleton, LCSW: Emotions that maybe are extreme. But like, wow, you see someone who a dead body, someone who's hanging very disturbing. And you have this emotional reaction because you're a human with you know, Lisa.
[17:38] Dr. Katrina Furey: Is not she takes her money and she goes I think, again, that was just such smart writing and depiction. I guess I was reading that didn't actually happen. Like, they didn't escape together. I was reading a little bit on Wikipedia about the author's take on this movie and I think she actually didn't love it. But there were some things that didn't actually happen like that scene. So whether it happened or not, I hope it didn't for daisy's Sake. But it was really smart writing to portray these two women who are both struggling psychiatrically, but with different personality flavors. And I think you do see some overlap between the Bpd and ASPD antisocial personality disorder, which, again, are all under the same cluster of personality development, like the provocative nature, the splitting, the intense mood swings, the all or nothing way of thinking and feeling and relating to people. But you see how antisocial personality disorder is different, right?
[18:36] Portia Pendleton, LCSW: There's lacking empathy, there's lacking people with Bpd can relate to others. They do experience emotions appropriately and sometimes extreme. It's not a lack of in most cases, it's intense.
[18:48] Dr. Katrina Furey: Exactly.
[18:48] Portia Pendleton, LCSW: Too many emotions.
[18:50] Dr. Katrina Furey: Right. It's a very intense emotions for the situation, but you still experience them. And they're not always, quote unquote, too intense. Sometimes they're totally accurate. But even, like, the scene with Susanna and Valerie where Susanna's in the bathtub, and she says awful things to thought. I don't know about you, but I felt like that was the scene where I really saw the Bpd side of Susanna. Kind of like until then, I was like, I don't really know if I buy that she has this diagnosis or if she's just, like, a struggling. Like, maybe it's a little too early to diagnose her with something like this, but then she really throws out, like, racial slurs, really derogatory things. Because I think Valerie was trying to connect with her. And I think for someone with Bpd, that feels very scary. Right. It's like you crave attachment, and you also fear it because you might lose it. So I felt like that was her trying to push her away in a really extreme way. And then later, though, you see that Susanna has a lot of remorse and guilt for what she said, whereas someone like Lisa would not. Daisy's character as well, is very you.
[20:04] Portia Pendleton, LCSW: Know, I think there's a lot there. I think also, if we're going on what Lisa said is true, which sounded like her dad was molesting her for.
[20:14] Dr. Katrina Furey: And again, like, no one else had kind of brought that up. And I do feel like people with sociopathic traits have this uncanny ability to sniff these things out and pull them out. Right. I don't know how, but they do. They can sense this stuff and pull it out and really dig at you. Yeah.
[20:34] Portia Pendleton, LCSW: We didn't know that until that scene where she was kind of pushed over the edge. But she talked about being wealthy a lot. It seemed like she was abusing laxatives. They were kind of trading colase for Valium, which can happen at residential or inpatient places. That's why you're typically supposed to show your mouth. You lift your tongue, move it around to show that you're not tonguing meds.
[21:00] Dr. Katrina Furey: Right. Or cheeking them or throwing them up afterwards before they've been metabolized. Yeah.
[21:07] Portia Pendleton, LCSW: So that's a part that's just I mean, it can happen, and it is.
[21:11] Dr. Katrina Furey: What it is, but it does happen.
[21:12] Portia Pendleton, LCSW: The trading is just so unhelpful, right? Because it's like you don't know what drugs you're trading something for that then you're taking could be interacting with something else that your prescriber is giving you that they don't know that you're doing this. Very dangerous do not do thought. And maybe you can speak on this a little bit. It was interesting, which I know would never happen.
[21:30] Dr. Katrina Furey: Right.
[21:30] Portia Pendleton, LCSW: So before she's seen by a medical and I'm talking about Susannah before she's evaluated or sees any psychiatrist, she's already taking medication and they're giving her laxative. Why?
[21:40] Dr. Katrina Furey: I thought they were giving her sleeping pill at first. Well, I guess they also give her choli. Right?
[21:45] Portia Pendleton, LCSW: Well, anyway, but any medication.
[21:47] Dr. Katrina Furey: Yeah. So there were definitely, I would say, some positive elements of the movie about the way they depicted mental health treatment back at that time. As it was. It could be at these beautiful institutions where you would have, like, a nurse's station. Then the patients would have their rooms. There'd be a common area. There would be other rooms like the art room, the music room, stuff like that. I think even nowadays, at more residential type places, you try to have that stuff so that during the day, you're not just sitting around, there's some therapeutic intervention. Right. So that I thought was pretty positive and spot probably, I would imagine McLean still might kind of look like that. The things that I thought were not great was that, like you said, she didn't see a psychiatrist at all and she's already taking medication. Like, that doesn't happen nowadays, and she.
[22:34] Portia Pendleton, LCSW: Wasn'T already on it.
[22:36] Dr. Katrina Furey: Right. It's not like they were continuing what she was on. But even for that, if you're admitted to a psychiatric hospital and you get to the unit at 03:00 in the morning, there's a psychiatrist on staff who will at least come and do a physical exam. Listen to your heart, listen to your lungs, check your blood pressure.
[22:52] Portia Pendleton, LCSW: You're getting labs.
[22:53] Dr. Katrina Furey: You're getting labs done. Maybe you need an EKG just because they might have hurts like a murmur or you're on a medication, they want to make sure that your heart is functioning okay, especially her, who just had a recent overdose. And then you go through like, do you have any allergies? What other medications do you take? Do you have any dietary preferences? Nowadays they also ask you what are your pronouns? All of this stuff happens the second you hit the floor. It doesn't wait till the morning. You might not meet your primary treater and get into the therapy side of things at 03:00 in the morning, but you would have that done, and you would talk about what medications they were going to prescribe or not and why and why. So I didn't like that. And you can't force anyone to take medication. That's the other thing that was inaccurate and made me upset, is like when susannah would express, like, I don't want to take this. You can't force them. That is totally coarse. If you can't do that, you need a court order to give anyone medication, which sometimes you do have to apply for, and sometimes it is granted. Like, if you have a patient with really severe chronic schizophrenia who needs their injectable antipsychotic to maintain wellness, that gets really tricky. But for stool softener, no one's forcing you to take a stool softener, okay? And like you said, they do like, tongue and cheek checks and make sure you are taking your medication. And they depicted that sometimes, but not all the time. But yeah, the chicken carcasses. What do you think about that? Interesting.
[24:20] Portia Pendleton, LCSW: I mean, it seemed like she does like, purge, right? So either laxative use or there was some alluding to maybe some binging, like some little bit of bulimia both at the unit and then when she was in her apartment. That made me think that again, I mean, I'm going very loosely making that diagnosis. I also would say that the other patient on the unit who appears to have anorexia, which the weird comment of she's like, yelling about wanting her clothes, and then the nurse says, then you'll have to eat something, does not happen.
[24:50] Dr. Katrina Furey: Now you can't manipulate people to eat.
[24:52] Portia Pendleton, LCSW: And also that's typically why there are now so many separate units. It's very unhelpful and doesn't happen frequently to have eating disorder patients within a general psych population. They are, I think, inpatient like, in a hospital can go to like a medical but even then there are very specific and I think there's really only like a couple in the country, but there's a Cute out west, and then there is Walden and McLean out east, where they have inpatient units specifically for that. Because I think it's so important for staff to be trained in a very specific way.
[25:32] Dr. Katrina Furey: I did think some of the stuff they portrayed, like not giving you your clothes until you eat doesn't happen. Other stuff, though, that they portrayed, like her exercising all the time on the unit, super accurate. And that's one of the things that the staff get trained in is like, being able to pick up these subtle ways of exercising in an attempt to burn calories and things like that.
[25:53] Portia Pendleton, LCSW: Well, a lot of patients will share that if they are admitted into a general hospital and they do have primary ed, it's often like the worst time, which, again, is probably for many different reasons. One, they're so medically compromised. Two, this is like the beginning of the long road of often. Then maybe you're switching to an inpatient ed unit and then residential and then PHP and then IOP. There is some controversy in the community with the ethics around tube feeding. There's even more controversy within it if you are being tubed placing and pulling same day or for each meal to get you off the tube, they want you to eat, and typically you're tubed if you're really malnourished or if you're refusing. Again, I don't think they can make you without a court order, but they'll do that if you're refusing.
[26:44] Dr. Katrina Furey: Yeah, I think that gets really tricky. And it's probably when they call for a capacity evaluation where a psychiatrist I would believe a medical doctor could do it too. Medical doctor being like internal medicine, someone who's not a psychiatrist, but still a physician would evaluate, does this patient have the capacity to refuse meals when they're this malnourished? Or is that malnourishment causing impaired cognitive what is the ethical decision of like can you make this decision knowing it's going to hasten your death or not? I mean, that's probably a huge ethical.
[27:18] Portia Pendleton, LCSW: And there was a case and the judge sided with the patient and the patient went on to die. They went into hospice. Just it's really horrible. Do not recommend. But these places are there for you because you are that know, you really need support. So anyway, Janet should be, I think, in a more specialized unit where she's getting meal coaching other than just being threatened or withholding other things.
[27:45] Dr. Katrina Furey: Right.
[27:45] Portia Pendleton, LCSW: I think there were some eating disorder places around Renfrew's really old. They started in Philadelphia. They're all over now, but they're like the oldest big center for eating disorder. So if they were open then she should have been there. I think she probably would have gotten better care and more specialized care. So she should transfer if it opens soon.
[28:07] Dr. Katrina Furey: Well, and I'm just thinking too, back in that time, in the mid sixty s, I feel like a lot of the treatment was still very psychoanalytic. Right. So I don't know how much about.
[28:16] Portia Pendleton, LCSW: Your mother, let's lie down and talk about your mom.
[28:20] Dr. Katrina Furey: And as a psychodynamic, psychotherapist I so fully believe in, there's huge connections cases in certain instances. Right.
[28:30] Portia Pendleton, LCSW: But we need meal coaching, we need behavioral treatment, which often is DBT, and we absolutely need but I will say, too, like at that level of care, it's really hard, I think, when you're also that malnourished to exactly do that.
[28:44] Dr. Katrina Furey: That's what I was going to say. Right. Like at the right time for the right patients. I feel like back then and again, I don't know, I wasn't alive in the 60s, but I feel like that's what everyone got.
[28:54] Portia Pendleton, LCSW: Yeah.
[28:55] Dr. Katrina Furey: And maybe that was like all we really had back then. We didn't really have the antipsychotics and stuff were just starting to come out. Maybe like CBT, DBT, these things, I don't think they were really out there yet. So yeah, I would imagine Janet was getting substandard care based on today's standards. And then it's like, well, I think Susannah was getting really good care based on today's standards. The difference in the comparison is really interesting.
[29:23] Portia Pendleton, LCSW: And I wanted to just if you haven't listened yet, check out our episode on Shutter Island. Because that was in, I think, around the same late fifty s the mid to early 50s. So that's not that far off from this movie. Maybe, though, ten years can make a difference. However, I think this is also, again, like a private institution versus a forensic state forensic unit. Right.
[29:46] Dr. Katrina Furey: But you're right, it's really interesting to sort of watch both of those and kind of compare and contrast them and they do get some of the historical points accurate. And I feel like back in the 60s, again, that was when a lot of these hospitals were being shut down in an effort to have people be treated in the community. Which again, is like, great, let's do it. But the money to actually do it, guys.
[30:08] Portia Pendleton, LCSW: Yeah, no, totally. That's a huge problem. Anyway, there was a lot of other things wrong, like the orderly having oh.
[30:16] Dr. Katrina Furey: My God, sexual relations. Even like them allowing her to make out or have sex with her boyfriend. No, you're not letting when people come to visit you, you don't just get to go behind closed doors and have a conjugal visit.
[30:27] Portia Pendleton, LCSW: It's like a therapy session or you're playing a game. It's out in the open visiting time.
[30:32] Dr. Katrina Furey: There's boundaries, especially for a patient like her. And how did the girls keep escaping and going to the basement all the time? There's people on staff overnight. The room check thing was accurate. You do come in and do checks at first, they are every 15 minutes. So I think that's really disruptive to your sleep. And we know how important sleep is to your mental health.
[30:51] Portia Pendleton, LCSW: So I've done checks. I only had to do one, thank goodness, because I'm not an overnighter gal. But when I worked at a residential, I did get mandated to stay once overnight. And having to do ten minute checks on a new patient, because typically when they're new, they're on the highest level of watch.
[31:09] Dr. Katrina Furey: Right.
[31:10] Portia Pendleton, LCSW: So it just sucks, a, because I wasn't used to being on night shift, but yeah, it's really hard to do as an employee or as a mental health professional. And then also, I'm sure the patient didn't love it either, right.
[31:23] Dr. Katrina Furey: Because they're not just like opening the door to see if you're there. They have to make sure you're safe. Right. So if you're turned and facing the wall and sleeping, they have to shine the light in your eye, make sure not only are you breathing, but you're not hoarding some sort of weapon or things like that. So that actually was accurate. But then I was like, if they're doing the checks, there's no one in the hallways. That's just not how it happens. I don't think they would have been able to escape. I thought this scene with them all reading their files was fascinating. And to me, it kind of reminds me of like, nowadays when patients have access to their notes and stuff like that, and how that is interesting and I think different for someone reading their note from their primary care annual physical and their therapy work. Right. What were your thoughts about all that?
[32:11] Portia Pendleton, LCSW: Yeah, I think we talked about this in another episode, but I'm going to bring it up again. You're supposed to write your note like there's a lawyer on one shoulder and the patient on the other. So I think though, with more electronic medical records and with more open chart things like we have my chart here, maybe that's international, maybe it's national. It's basically where you can log in, send a message to your provider, look at your lab work, et cetera, schedule appointments, also see the notes. And so there are some questions around is it helpful or not for that to be in the mental health world? And is there like a level of notes that should be shared versus not what's helpful?
[32:51] Dr. Katrina Furey: What do you think?
[32:52] Portia Pendleton, LCSW: I think that patients should absolutely have access to treatment plans. I think that having access to all of your notes all the time, reading them on your own, is unhelpful. I totally agree. I think if you need to see the notes, you should be going over them with the provider so you can explain things. So if there's any questions or context, they can ask questions and not feel any kind. It shouldn't be negative. And they might be like, oh, well, what is that? What did that mean? And then you're there to explain exactly what that meant.
[33:29] Dr. Katrina Furey: Right. I think, though, kind of like these women reading their files, it can be jarring. I don't think I'd want to read my psychological assessment of myself by myself. I feel like that's like really I.
[33:43] Portia Pendleton, LCSW: Think it's more damaging it can be.
[33:45] Dr. Katrina Furey: And I think it can really damage the therapeutic alliance with your provider too, because not everything you're observing the patient's going to see and that's going to.
[33:55] Portia Pendleton, LCSW: Be it might not be ready to see.
[33:56] Dr. Katrina Furey: Right.
[33:57] Portia Pendleton, LCSW: And I'll just say too, just for clarity, we're not talking **** about you in your notes, we're writing things from our perspective, from our professional perspective of what's happening. Sometimes maybe we're wrong too, interpreted something wrong. So it's really for documenting purposes, it's for billing.
[34:17] Dr. Katrina Furey: Yes.
[34:17] Portia Pendleton, LCSW: And sometimes we might not do it perfectly. So I think that's I would lead.
[34:22] Dr. Katrina Furey: With that preference and I think with, again, notes and stuff like that being more and more open, I feel like they've just become less and less helpful. I guess you leave so much out and you just have to keep it in your head, right, that it's kind of unfortunate. I do find myself being like, well, if this person ever read this, how would they feel about this? And I do think that can go both ways. On the one hand, I think it can help you remain not compassionate, but help you stay in a neutral space. And a lot of times be mindful of your own unconscious biases and be like, well, why am I putting this word in? Does it really need to be there or not? And on the negative side, it can make you withhold things that really should be there, but you're worried about if they read it before they're ready, how is that going to affect them? How will that affect our therapeutic alliance and their future treatment? And is that worth it?
[35:23] Portia Pendleton, LCSW: Right?
[35:23] Dr. Katrina Furey: Is that potential negative effect worth it? It's real tricky.
[35:27] Portia Pendleton, LCSW: It is. No, I totally agree. It's nuanced. I think most providers feel the same way we do.
[35:42] Dr. Katrina Furey: But I did think how interesting that this film, filmed decades ago, based on a time even further in the past, is still, like, on the pulse with something really active, like, in the mental health field presently. And I also thought it amazingly depicted how mental health providers really struggle to tell people their directly. It seems like none of these girls really knew, what am I here for? What am I being treated for? Some of them did. They were like, oh, Elisa, you're a sociopath. We all know know. But, like, Susanna being like, borderline personality disorder? What is that?
[36:19] Portia Pendleton, LCSW: And then when she's in her family therapy session, she's like, what is that? And apparently the doctor's been telling her parents, but not her.
[36:27] Dr. Katrina Furey: Right? And she is an adult. This isn't like a 14 year old. And especially, I don't know about you, Portia, but I feel like in the mental health field, we tiptoe around this diagnosis, and so we're so hesitant to talk about it and share it with people. And why do you think that is?
[36:44] Portia Pendleton, LCSW: I think because societally, there are negative connotations with it. And I think that at least that's my discomfort sometimes. Versus I think the more we accurately diagnose people who have Borderline and talk about it, the better care they will get, because then we know the treatment plan and they can get better. We have more than people to participate in studies, there's more research. I think we really should be accurately diagnosing the disorder and also teaching clients about it and giving them education is, like, best practice. But I think in our society, like, Bpd has a lot of negative even I think it's even, like, joked about, you're crazy, and it's females. Obviously, we're careful of that, but I think ultimately, it does more damage, not sharing or being, for sure, hesitant. But again, diagnosing someone with a personality disorder does not happen immediately. One assessment, you're getting there with tons of data and information, and over time, it's like, you're probably there, right?
[37:47] Dr. Katrina Furey: Let's just call it what it is, right? But yeah, I think that reminds me of, like, early on in the movie. I think it's in this scene when she's reading her file and she sees a cluster of diagnoses at the beginning. I can't remember what they were. Do you remember what they were. Yeah, they're not accurate today anymore. We call them different things now.
[38:09] Portia Pendleton, LCSW: So it says Psychoneurotic Depressive Reaction, personality Pattern Disturbance resistant, mixed type, and then undifferentiated schizophrenia.
[38:21] Dr. Katrina Furey: Those were yeah. And then all of a sudden, at the bottom, it's like, final diagnosis borderline Personality disorder. So can you imagine? Again, it's like, okay, she's reading all these words. Like, even as a psychiatrist, I don't understand what those early diagnosis mean because we don't use them anymore. They're a lot of big words that are confusing. So it's really hard for her to make sense of, like, what does that mean? And she goes and grabs it, looks like a DSM or something, and starts reading about it and is, like, all up in arms. And I just think, what a sad way for her to find out and then to also hear it in the family therapy where her parents know before she knows, but we're all keeping it.
[38:55] Portia Pendleton, LCSW: Quiet, like talk about it.
[38:58] Dr. Katrina Furey: And I think I loved when she said borderline of what? Like, what does that mean? And, you know, the way I was taught to think about it and where I think the phrase comes from. And again, I will say I don't love that we call certain things personality disorders. I feel like even that phrase is really stigmatizing. I don't know of a better one, though.
[39:21] Portia Pendleton, LCSW: So much of we find in patients who have borderline personality disorder, there typically is some sort of attachment trauma.
[39:28] Dr. Katrina Furey: Yes.
[39:28] Portia Pendleton, LCSW: And so I would love for there to be a more specific trauma diagnosis other than PTSD or complex PTSD that talks more about attachment and how that then impacts relationships. I think that would be so much more helpful, better fit for people to understand.
[39:46] Dr. Katrina Furey: Right, 100%. And I think when we use the word borderline, I believe where it came from is, again, harkening back to those psychoanalytic days, which we see in this movie of thinking about what are the defense mechanisms different people with different illnesses tend to use to live with and cope with their illness. And when we think of people in broad strokes, we think of people falling into what we call, like, the neurotic realm of personality development. These are people with, like, anxiety disorders, OCD, things like that, eating disorders. And then we think on the other end of the spectrum are people with psychotic disorders who use different types of defense mechanisms that are disconnected from reality, whereas people with neurotic disorders are maybe like uber connected to reality or a little too in their head. Borderline falls in the middle, where you sort of display some neurotic defense mechanisms and some psychotic defense mechanisms that doesn't make sense to the average person. And even as I'm trying to explain it, it's really confusing. But these are patients she did say in the movie, which was accurate, with an unstable sense of self, unstable moods, like a lot of mood swings again, some safety concerns in the most severe cases, which we see with her right at the beginning. But, again, it's like what I also loved about this movie was when they captured her at this age because some of these personality traits, again, not the safety concerns, like, we'll put that over here on the side. But some of the other stuff, the big mood swings, the idealization devaluation, the splitting that is normal in development from when you're very young, like, born to as you're growing up into adolescence. And then as your brain matures and you mature, you're able to sort of hold on to good and bad feelings and thoughts simultaneously. But that takes time. It does. And so a lot of people are also really hesitant to make this diagnosis, I hope, in a teenager or young adult, until you really see these traits and these issues sort of being persistent and present across all different facets of someone's life and over a long period of time. Otherwise, it does raise the question of is this just quote, unquote, like normal adolescent angst, like the suicide attempt? No, but some of her questions to Dr. Wick, like, well, how many partners is promiscuous? And what is it for a man, like, totally trapped, right?
[42:21] Portia Pendleton, LCSW: And for the time, just thinking of being in the think thinking of Susannah and then her mom, I would say probably very different expectations for how to behave. They talk the Vietnam War. There's a draft going on. So I think this is also just like, a very culturally changing time for so many behaviors might seem so unsafe besides the safety safety issues, like the promiscuity that they keep talking about to even the doctors, right? Because they're of that other generation as well, that maybe is having just more of that judgment or thinking it's more of a behavior than her. Just like right in the 60s as a young adult, like, expressing herself and her sexuality, right?
[43:02] Dr. Katrina Furey: And then it's like, well, yeah, and having sex with an older man who's married. Again, I felt like there was so much almost blame put on her. But it's like, what about him? Right?
[43:15] Portia Pendleton, LCSW: The mom are there at the ice cream store for that scene, and that wife and daughter come in, and Susanna susanna's trying to kind of hide herself initially. And then the mom sees her, comes over and is like, It's her fault. And it's also like, okay, but of course, right, like, you're so you're not blaming the adult in the situation, your husband, who's and, you know, she's single, she's young. Of course it's her fault, right?
[43:41] Dr. Katrina Furey: There's all these assumptions and a lot of blame on her. But it's like, what about him? And taking advantage of a younger girl. And again, not saying that there aren't cases where maybe the younger girl is more of the instigator, I guess you could say. But still, I was like, I see her point here.
[43:58] Portia Pendleton, LCSW: Well, and then he was continuing to want to follow up, and she remember at the beginning like, no. And kind of shuts the door on him. So even that felt like it was a little bit more on him, or else it was going to be more on him. But at the ice cream scene, I do think that that is when Susanna does kind of or Lisa's actions to kind of save Susanna is where Susanna does really align with her, and that's how that then, you know, then Lisa gets her trust on her.
[44:24] Dr. Katrina Furey: And I think Lisa, with her sociopathic traits, can sniff out who's vulnerable. And I do think people with Bpd are vulnerable to attracting toxicity or finding themselves in these toxic relationships. Like, hearkening back to Tanya from White Lotus. As we're talking now, I'm wondering if that suicide attempt was somehow connected to that relationship with that man. Like if in some way she felt rejected and then attempted suicide. And if somehow, maybe the doctors knew that and we didn't quite hear that as a viewer. But that, to me would give more of more evidence for a true Bpd type of diagnosis where really the core inner wound and fear is related to attachment and feelings of abandonment or rejection are really hard to navigate, I think. As we wrap up, I wanted to just ask you, do you think Lisa would have actually been crying at the end? I did think her and the four point restraints were those are what restraints look like. Even these days, restraining someone is like the soul crushing thing that you have to do sometimes as a psychiatrist on inpatient units like this, when there's a real safety issue happening, we try to do it in the least restrictive way as possible. You do see another character earlier in the movie in a straitjacket. We really don't use those anymore, but what you saw depicted is what strait jackets looked like, and they were used back then. Do you think Lisa would have cried with Susanna's departure?
[45:57] Portia Pendleton, LCSW: If the tears were real, they would.
[45:59] Dr. Katrina Furey: Have to be about she's.
[46:03] Portia Pendleton, LCSW: Yeah.
[46:03] Dr. Katrina Furey: I don't think she's feeling sad to lose her friend. I think she's being manipulative. The tears are real about her to make Susanna feel bad for saying all those things. I think that is what it is. But I don't think a true sociopath is capable of having tears or really know if someone's coming or going. Right.
[46:23] Portia Pendleton, LCSW: I also think, just like to add to Lisa is that the reason that we wanted to deinstitutionalize people is because you can become institutionalized, where you get used to living in a state like that, which I would also say you're around trauma a lot, and chaos. It's scary setting things. So I think that also, after eight years, I would imagine changes someone, and.
[46:48] Dr. Katrina Furey: You become dependent on the institution.
[46:50] Portia Pendleton, LCSW: Like, why she's there, sure. But for her to be there for eight years, I think also must impact her everything. So I'm just curious, even just thinking about what has that done to her? That's why we like to keep people in the communities, in their communities. It is what's best when there are enough resources. So I think that's also just something to think about, like, how have the eight years been there for her, impacted her?
[47:19] Dr. Katrina Furey: Right. It's kind of like what we see when people are in the criminal justice system for a long time, then they get released and they reoffend and come back. Sometimes they don't know how to survive anymore, like, outside of an institution like that.
[47:32] Portia Pendleton, LCSW: All right, well, thanks for joining us today. We hope that you enjoyed today's episode. If you did, please feel free to rate the episode with five stars and then check us out on Instagram at Analyze Scripts and TikTok at Analyze Scripts podcast. And we would love for you also to subscribe. We have gotten a little bit of a bump this week and we're really.
[47:51] Dr. Katrina Furey: Excited about it, so we do see.
[47:53] Portia Pendleton, LCSW: Every subscriber add on. It brings us joy. So if you'd like to participate in.
[47:56] Dr. Katrina Furey: That, feel free and spread the news. All right, see you next Monday.
[48:00] Portia Pendleton, LCSW: Thanks.
[48:00] Dr. Katrina Furey: Bye bye.
[48:07] Dr. Katrina Furey: This podcast and its contents are a copyright of analyzed scripts. All rights reserved. Any redistribution or reproduction of part or all of the contents in any form is prohibited.
[48:19] Dr. Katrina Furey: Unless you want to share it with your friends and rate, review and subscribe, that's fine.
[48:23] Dr. Katrina Furey: All stories and characters discussed are fictional in nature. No identification with actual persons, living or deceased places, buildings, or products is intended or should be inferred. This podcast is for entertainment purposes only. The podcast and its contents do not constitute professional mental health or medical advice. Listeners might consider consulting a mental health provider if they need assistance with any mental health problems or concerns. As always, please call 911 or go directly to your nearest emergency room for any psychiatric emergencies. Thanks for listening and see you next time. Don't.
Hosted on Acast. See acast.com/privacy for more information.
