This chapter, an explanation of Kaysen’s diagnosis, is taken from the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III). The most prominent characteristic of a borderline personality is an uneven sense of identity. This instability manifests itself in conflicted relationships, an inability to make ethical choices, confusion about sexual identity, and a persistent sense that one’s life lacks meaning or direction. Fear of abandonment is common, as are intense mood swings. Stress can trigger suicidal or self-damaging impulses, including reckless behavior, random sexual encounters, and petty crimes. People suffering from borderline personality disorder typically have difficulty operating in traditional social environments. Women are more likely to be diagnosed as borderline than are men.
Kaysen responds to her diagnosis as a borderline personality. McLean Hospital was reluctant to release her records, so Kaysen sought the aid of an attorney. She believes that the DSM-defined diagnosis describes her eighteen-year-old self fairly accurately. Kaysen questions whether the definition’s allegation that borderline personalities have difficulty choosing “friends or lovers” is evidence of illness. She continues to struggle with this issue today and believes that most people do. Kaysen thinks that a borderline personality is evidence of a psyche damaged but not shattered. She notes that diagnoses are often attributable to trends; each decade sees a popular diagnosis come and go. Occasionally, a diagnosis, such as homosexuality, is removed entirely from the annals of psychiatry. Reading further through the definition of borderline personality disorder, Kaysen points out that “uncertainty about . . . long-term goals or career choice” seems to be applicable to most adolescents.
She stops here to warn the reader that some of her behavior as a teenager likely was evidence of mental illness. She made a practice of banging her wrists repeatedly against the hard metal struts of a butterfly chair and scratched her face methodically. Kaysen takes issue with the definition’s charge that “pessimism,” “social contrariness,” or “chronic feelings of emptiness or boredom” are anything other than descriptions of common teenage maladies. Kaysen tells us that she was the first student in her school’s history not to have attended college—a distinction that invited concern from peers and parents. Most troubling to Kaysen, however, is the fact that more women are diagnosed as borderline than are men. She argues that women are often diagnosed with illnesses that appear suspect when examined, such as “compulsive promiscuity,” a charge not often leveled at men. A number of the behaviors noted in the definition are also commonly identified with women, including shoplifting, binge eating, and excessive shopping. Kaysen tells us that she is vigilant about analyzing her behavior for signs that she might be “crazy.” Having experienced the world of the mentally ill, she wants never to return to it.
Kaysen sees two of her fellow patients some years after she has left the hospital. Georgina visits Kaysen in Cambridge, rudely interrupting Kaysen’s older neighbor, who is baking bread. Georgina clearly has little grasp of social courtesies and shocks the neighbor with her tactlessness. Georgina eventually marries, and Kaysen visits her old roommate on the farm where she lives. Kaysen also runs into Lisa one day. Lisa has a child now and describes, to Kaysen’s surprise, the suburban life she has created for herself and her son. Lisa mentions McLean in passing but seems to have changed quite a bit as a person. However, quirks in her conversation and behavior betray her new persona.
Kaysen speaks about her relationship with her high school English teacher. He takes her to New York to visit the Frick Museum, where Kaysen expects that he will try to kiss her. In front of a painting of a student seemingly trapped by a music teacher, Kaysen imagines that the girl warns her not to pursue the relationship. Kaysen ignores the imagined advice. Years later, Kaysen visits the museum again with a wealthy, unkind boyfriend. She returns to the painting but interprets it quite differently. The painting is titled Girl, Interrupted at Her Music. Kaysen tears up as she recalls how her own life was interrupted by illness and hospitalization. She considers the light in the painting and compares it to the light cast by life, which often fails to reveal to us the nature of ourselves and other people.
Kaysen “annotates” her diagnosis of borderline personality disorder and the “charges against [her].” In this chapter, Kaysen acknowledges that she was troubled as an adolescent, but she resists several of the diagnostic interpretations of her behavior. She admits to having exhibited several of the diagnosis’ features, including vagueness of purpose or long-term goals, uncertainty in relation to friends and romantic partners, and general instability. But these behaviors do not necessarily indicate mental illness. Most teenagers waver when pressed about long-term plans, and indecision on the matter of friends and lovers might be universal. Further, Kaysen notes that psychiatric diagnoses follow trends; some “disorders” are eventually identified as normal behavior. Having called the very fact of her mental illness into question, Kaysen then mentions some behavior that must “irrefutably” have indicated “an inward condition.” Ritual banging of the wrists and face scratching allowed Kaysen some visual evidence of the pain and turmoil she felt inside. Having classified at least some of her conduct as abnormal, Kaysen retreats into ambiguity once again. Outwardly, her behavior at school was most likely the mild rebellion of an unhappy teenager. She also notes the sexist nature of the borderline diagnosis: many of the behaviors are female-identified, and the illness is more often diagnosed in women than in men.