Themes are the fundamental and often universal ideas explored in a literary work.
Kaysen carefully skirts around the issue of whether she was ever truly ill. Her ambiguity exposes one of the central themes of the memoir: the line between sane and insane, normal and deviant is a blurry one. More importantly, it is a distinction that, except in the most desperate instances of mental illness, scarcely captures the personality it seeks to classify. The distinction between “normal” and “crazy” can be so fine, she argues, that our insistence on making it is shortsighted at best. After all, even in the case of the demonstrably insane, “is a nonreality-recognizing brain truly as different from a reality-recognizing brain as a foot, say, from a brain? This seems unlikely. Recognizing the agreed-upon version of reality is only one of billions of brain jobs.”
Kaysen confronts her diagnosis as a borderline personality line by line, making its imprecision clear. Charged with “uncertainty about long-term goals,” “instability of self-image,” and “social contrariness,” Kaysen wonders whether every teenager might satisfy these classifications. She admits to having been a troubled adolescent, behaving rebelliously and rejecting the goals set out for her by parents and the educational system. Yet these behaviors were clearly not predictive of her adult life. Early in the memoir, Nobel laureate James Watson visits Kaysen on the ward. She describes her warm feelings for him, derived primarily from Watson’s refusal or inability to follow social convention. His eccentricity does not impede his powerful intellect.
In several instances, Kaysen admits to self-destructive behavior during adolescence and seems to concede that she was clinically ill. In her portrayals of Alice, Daisy, and Polly, however, she presents examples of people truly incapacitated by mental illness, juxtaposing their predicaments with her own and others’. She argues that a point exists at which people require treatment, hospitalization, and even isolation from others. Yet we are far too quick to pass this kind of judgment. Her two-year confinement, and the consequences that resulted from it, convinced Kaysen of our profound need to define people within conventional social norms. The costs of those decisions are high.
When Kaysen enters McLean Hospital, she quickly comes to understand that although captivity appears to require the surrender of freedom, the opposite is often true. The ward is organized to keep patients exposed to staff scrutiny at all times. With nurse checks at frequent intervals, every room is essentially public except for one. The “seclusion room” sits at farthest reach of the main hallway, intended for out-of-control patients who pose harm to others or simply make too much of a disturbance. Patients can also choose to be placed in the room, prompting Kaysen to remark, “freedom was the price of privacy.” Here, a patient can be blessedly alone for a period, free from scrutiny and company but confined to even tighter quarters. The seclusion room is a microcosm for the entire experience of confinement to the hospital. Kaysen notes that McLean is “a refuge as much as a prison.” Without school, a job, bills, parents, or the outside world to deal with, the girls are free to ignore responsibility, even as that responsibility has been taken from them. Kaysen finds that this apparent paradox isn’t confined to the hospital. After nearly two years at McLean, Kaysen looks for a means to leave but finds that her hospital stay stigmatizes her in the eyes of employers. A marriage proposal turns her circumstances on their head. “Everyone could understand a marriage proposal,” she writes, despite nearly total uncertainty about the appropriateness of her fiancé or the appeal of marriage itself. The engagement frees Kaysen from the confinement of the hospital, but it limits her opportunities.
Women continue to face prejudice and discrimination today, but these phenomena were more overtly evident during Kaysen’s adolescence. She faces sexism of a crude kind in her typing job at Harvard, prior to entering the hospital. The supervisory staff is comprised entirely of men, and the typing staff is only women. Kaysen is bewildered by the obvious inequities she faces in the workplace. She is forced to obey a strict dress code and is particularly incensed by the fact that women are allowed to smoke only in the bathroom, on breaks. She faces job-related discrimination again when she tries to plot her life post-hospitalization. Counselors urge her into intellectually undemanding service jobs; she is startled when even Valerie, the confident head nurse, seems to nudge her in this direction. Only a marriage proposal, offering the most traditional kind of female role, saves her from becoming a dental technician. Sexism also appears in Kaysen’s diagnosis of borderline personality disorder. The illness, she tells us, is most commonly diagnosed in women, and the symptoms are almost universally identified in women. Shoplifting, compulsive shopping, binge eating, and promiscuity are not usually characteristics that are associated with compulsive male behavior. Although opportunities for women began to expand rapidly in Kaysen’s youth, American society was still full of the most vulgar of old-fashioned behaviors and prejudices.