Child and youth mental health issues

This case study is on Susanna Kayson in the Girl, Interrupted movie. She is a young, 18 year old girl that has just graduated from high school. She is confused about her life and the direction it is going and this frustrates, as well as depresses her. Her family and peers around her have high expectations of her which she feels she cannot and does not want to meet. She feels incomplete and lost because she is not following the footsteps of her fellow peers. After a nearly successful suicide attempt, she is recommended to stay at the Claymoore mental institution.

Here she is diagnosed as having borderline personality disorder. At this institution, at first, she was not used to the loud chaos of all the different patients and their different disorders, she felt she didn’t belong there. However, she starts to learn more about each of the patients and overtime she starts to feel at home, the institution is the only place where she actually has friends. In high school, Susanna was out casted and her peers considered her weird, in the institution, there are no expectations or judgement casted on her and she is allowed to be herself.

Susanna was progressing in her treatment plan until she became friends with one of the other patients named, Lisa. She lost interest in trying to get out of the mental institution and therefore stopped caring about her treatment plan. It wasn’t until she realized how mean and manipulative Lisa was that she was able to continue on with her treatment. She finally was able to take advantage of the mental institution and the staff members, as well as the doctors and recover from her disorder, and eventually got released a year after she was admitted.

She learned how to cope with her feelings by journaling and her stay at the mental institution gave her a chance to think about what she wanted to do for a living as well which finally gave her the feeling of being complete and finally sure about what direction she is headed in. (Mangold, 1999). Section I Susanna is diagnosed with borderline personality disorder. According to the DSM-IV-TR regarding borderline personality disorder, a person can only be diagnosed as such if they have at least 5 of the following symptoms that persist consistently.

Extreme reactions, examples of this would include panic, depression, rage, or frantic actions, anywhere to abandonment, whether it is real or deduced. A pattern of intense and difficult relationships with family, friends, and loved ones, usually ranging from extreme closeness and love to extreme dislike or anger. Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future. Impulsive and normally dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating.

Recurring suicidal behaviors, threats or self-mutilating behavior, such as cutting. Intense and highly changeable moods, with each episode lasting from a few hours to a few days. Chronic feelings of emptiness and/or boredom. Inappropriate, intense anger or problems controlling anger. Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality. (National Institutes of Health, 2013). Susanna has borderline personality disorder because she exhibits many of these signs and symptoms.

She shows impulsive behaviour because she does many things without thinking about it and not thinking about the consequences to her actions. Also, she shows signs of self-mutilation, such as banging her wrist until it is completely bruised, while doing this she is also having an out of body experience because she does not realize what she is doing, which is considered a dissociative symptom. The fourth sign she shows is the distortion of her self-image as well as her sense of self, she is confused about her life and what she should be doing, she feels lost and confused about what direction she wants to head into.

The fifth sign is that she is depressed, she does not make friends easily and mentions faking a smile and pretending she is happy when she’s not, and all she feels is the need to want to kill herself. Section II Susanna shows one of the symptoms of borderline personality disorder when she attempted suicide in her depressed state. Following her graduation from high school, Susanna had ingested an entire bottle of aspirin followed by a bottle of vodka. She was out casted by her peers because they were all going to college and had some sort of direction of where they were going in their lives.

Susanna, on the contrary, was the only one out of her graduating peers that decided not to go to college, she felt lost, confused and empty, and there were so many people who had high expectations for her and she felt she could not meet these expectations, which lead to her depression. (Mangold, 1999). The second sign of her disorder is her promiscuity, which is a sign of impulsiveness “ in activities that are self-damaging, such as casual sex. ” (Mangold, 1999).

An example of her impulsiveness towards sex is the fact that she had an affair with one of her parent’s friend’s husband. Knowing full well that he was a married man with much to lose, she pursued a sexual relationship with him. Also, her boyfriend Toby came to visit her at the institute and right away she wanted to have sexual relations with him. He had tried to convince her to run away with him because he loves her and she refused, telling him that she would eventually leave the institution but not with him.

This is a sign that she does not have as much feelings for him as he does for her and that her relationship with him is purely sexual. (Mangold, 1999). Another sign of her borderline personality disorder is her depersonalization, dissociative nature when self-mutilating. An example of this is during the scene in the beginning of the movie where she is in the hospital with a wrap around her wrist. After the wrap was removed, there was visible evidence of bruising around her wrist, the doctors and nurses had referred to her as a “ wrist banger.

Susanna then continued on to say she has no bones in her hand, a sign that she was outside of her body when banging her wrist to cause the bruising, feeling no pain. (Mangold, 1999). Section III Axis II – Borderline personality disorder falls under axis II because it is a personality disorder and not a clinical disorder which falls under axis I. It is considered a cluster B personality disorder because people with borderline personality disorder are impulsive, and their relationships, emotions and self-image tend to be unstable. (Behave Net, 2013).

A few examples of Susanna showing signs and symptoms of borderline personality disorder is that she has casual sex, she self-harms, self-mutilates, she is depressed, unsure of where her life is going, she has a hard time making friends and did not have friends in high school, and how she disassociated herself when banging her wrist until it bruised entirely. (Mangold, 1999). Axis III – Two neurological problems regarding Susanne’s current psychiatric issue would be anxiety and depression. (WebMD, 2011). Susanne Kaysen, exhibited signs of anxiety and confusion when questioned about her plans and goals for her future.

She was asked “ You have the distinction of being the only senior at Spring Brook not going on to college, may I ask what you plan to do? ” (Mangold, 1999). Susanne says she plans to write, and the lady asks again “ But what do you plan to do? ” this causes Susanne to become anxious, fearing that her response did not meet the expectations assigned to her. An example of Susanne’s depression is that she attempted suicide by ingesting an entire bottle of aspirin combined with an entire bottle of vodka. (Mangold, 1999).

Also, Susanne has a flashback of post-sex with her boyfriend Toby, the two are lying in bed talking about suicide and Susanne expresses her thoughts about the subject matter. Toby does not share her enthusiasm and tells her he doesn’t want to talk about it anymore because it’s stupid and Susanne quickly gets up, gets dressed and prepares to leave while Toby yells out “ what? cause I don’t want to kill myself, that’s not cool to you? ” (Mangold, 1999) implying that Susanne was actually seriously considering suicide and was offended that Toby thought it was stupid of her to think that way.

Axis IV – A few psychosocial stressors that Susanne has faced during the movie would be being the only senior graduating from Spring Brook high school that is not planning to go to college, questioned and scrutinized by her school counsellor about her career choice, being admitted to a mental institution after attempting suicide, becoming comfortable and making friends in Claymoore, having Lisa, her closest friend transferred to a different wing of the institution, and discovering Daisy, a friend, dead ue to suicide. (Mangold, 1999). Section IV A number of risk factors for Susanne that are apparent in the movie, “ Girl, Interrupted”, include residing in an upper class neighbourhood, being scrutinized about her career choice, and being admitted into a mental health institution. Since Susanne grew up in an advantaged, upper class area, there are higher expectations of her, her plans and goals for her future from her family, and her peers.

The want and need to meet these expectations laid out for her but knowing she’ll fall short, is one of the reasons behind her anxiety. This risk factor would be considered to be in the exosystem because it is expressed from her external environment and the people around her in her neighbourhood, and not as much from her family. Another risk factor would be scrutiny regarding her career choice of becoming a writer by her school counsellor. After Susanne expresses she wants to be a writer, the counsellor inquires again, “ But what do you plan to do? (Mangold, 1999), insinuating that Susanne’s career choice does not meet the required expectations which causes her to doubt herself and become more depressed. This risk factor would be considered in the microsystem because it is coming from her school and is affecting Susanne wholly. The third risk factor is being admitted into Claymoore mental health institute. She was coerced into the institution against her will, and this causes her much anxiety and uncertainty.

This factor would be categorized under the microsystem part of the ecological system because it is in a hospital environment which is considered a health service; she also remains there for a year and has friends who affect her directly. Conclusion In conclusion, in the movie “ Girl, Interrupted” Susanne struggles with external, internal and social influences which causes her to display signs and symptoms of borderline personality disorder. Not only does she display these signs and symptoms, when she was admitted into Claymoore, she was properly diagnosed with borderline personality disorder by a physician.

Although this disorder has been mentioned to be genetically inherited, there is no evidence in the movie to suggest this, as Susanne’s parents don’t evidently exhibit any signs or symptoms. However, the only thing to have triggered the borderline personality disorder behaviour in Susanne’s case would be her environment as well as her social influences. (WebMD, 2011). This movie is a great depiction regarding the signs, symptoms, and treatment of borderline personality disorder.

References

http://www. imdb. com/title/tt0172493

http://www. nimh. nih. gov/health/topics/borderline-personality-disorder/index. shtml

http://www. webmd. com/mental-health/tc/borderline-personality-disorder-topic-overview