Skinny Dipping Into Books

Review currently unedited)


"In April 1967, 18-year-old Susanna Kaysen is admitted to McLean Hospital, in Belmont, Massachusetts, after attempting suicide by overdosing on pills. She denies that it was a suicide attempt to a psychiatrist, who suggests she take time to regroup in McLean, a private mental hospital. Susanna is diagnosed with borderline personality disorder, and her stay extends to 18 months[5] rather than the proposed couple of weeks."







South Belknap:
Built in 1894 in the Jacobethan Revival style, South Belknap was designed by architects Fehmer and Page, originally as the Belknap House for Women. Today, it houses one of the region's oldest and largest geriatric psychiatry programs dedicated to treating the mental health needs of senior men and women.



(note: photos below NOT of SB 2. representation of past and present Mclean's)

The only way to stay sane is to go a little crazy.

Initial thoughts @ 6am:

Five stars Because even though it's flaws, the pacing off with chapters skipping between introspective analysis and the auothor's experience at McLean, it's still miles better than the rubbish consuming mental health focused bios/autos/memoirs. *coughs Marya Hornbacher* ; except for Unquiet Mind, but duh.



six hours later:


The more i thought about it, the less i agreed with myself that this novel was a five star book.... lets back up a bit and give you context.

The diagnosis (DX)





Borderline personality disorder

Personality disorders are the highest form of a formal diagnosis; the most dangerous, both to the person diagnosed and for insurance purposes (it goes on your permanent record, so to speak); the most implications. In college you are warned repeatedly NOT to take these chapters lightly (not that you are told that you should throw a depression DX around). This is because its labeling and categorizing someone who has pervasive, sustained, and inflexible personality that "deviates from the expectations of the individuals culture" (DSM4). In short, you can't fix this shit (it's character.... personality). In truth you can sorta,depending on the DX, alleviate symptoms. Take Borderline PD. The irritability can be lessened with something like seroquel (enjoy your diabetes). RAPID, unmanageable, seemingly unpredictable changes in mood can be aided with Depakote (enjoy hair loss), Tegretol (temporal lobe disruptions), maybe Lamictal (twitch much? wanna rash that scars [im being sorta dickish at this point. this drug is one of the best of the best and, other than those symptoms is side effect neutral) etc. Sometimes antidepressants are prescribed. However, in reality, you will be in therapy the rest of your life (DBT, and CBT primarily); but this will help the best.

Specifically, according to the short blurb in the DSM4TV (I'm not going to dig out 5, sorry), BPD is "a pattern of instability in interpersonal relationships, self image, and affect, and marked impulsive". Also, according to the DSM4, these individuals maintain greater stability (meaning?) between the 30 and 40 y/o.

Suicide is greatest in younger patients. Self destructive acts are fairly common, and are often the result of a fractured (or perceived) loss of attachment, or to push attachment partners towards them (there is this push and pull sort of aspect to this DX). Self mutilation is different than the average cutter, and brings with it an attempt to make him/herself feel 'real', particularly during dissociating.

The unfocused teenager is a good lens to view this DX through, but only as a metaphor. the BPP has an unstable identity, but it's not related to the common thread tying all teenagers together (am i gay? straight? what do i want to do with my life? how do i want to do it? do i have money to do it? what do i like to do for fun? who are my friends? I hate my parents. I love my parents). It's not a typical identity crisis. For most, if not all of us this process is, well a process; starting at one point of struggle and bumping along until you reach a decision, which will probably result in a useless degree in literature or psychology, a regret you didn't go to state and now have 100 grand in student loans, and an overall feeling that following your school sweetheart to NYC wasn't the best idea (Note, Felicity [the show], is as far into the teenager crisis situation that one should go). the BPD patient's life is densely populated with changes to goals, values, sexual identity, friendships, role models, career choices, school choices... life choices. they are SUDDEN and often lack that unique decision making process that the normative population has; it's widely more complex than that, but the comparison is relevant.

Oh mood... people often say that BP are 'moody bitches'. Periods of anger, depression, irritability, anxiety, etc last often for just a few hours (some bouts [minutes to hours] of mood can occur), but no more than a few days. As the lovely DSM points out, these are often a reaction to INTERPERSONAL stress (don't confuse this with transitioning, or situational stressors [you are allowed to be a bit angry and pissed off at the world if a love one dies, or you get some extreme type of physical sickness]).

They are bored, but not because of a need to move, need to do, need to expel energy (bipolar), but because of a reaction to feeling all the time, relentlessly empty. Inappropriate anger and extreme, harsh sarcasm towards others (bitter, verbal outbursts that are often, if not always out of context with their surroundings) specifically towards caregivers that he/she feels are abandoning them—DSM says that shame and guilt follow. Transient paranoia is a factor when dealing with some extreme stresses.

prevalence: 2 percent of the general public and 20 percent among psych units. the population consists mostly of women.

OK.... get to the freaking book already


The memoir follows a very simple style. its sentences short, and its words not complex. It avoids the pretentious overtones of books that sit next to it on the shelf (Prozac Nation), as well as the frantic urge to prove something (Madness). However, there is a very clear line that one must not cross in order to present a valid, credible text. Susanna Kaysen crosses that line three or four times with changes to pacing, style, and overall content. Mind versus Brain was a disaster. First, it reflected a very old way of approaching therapy and mental health ( Freudian); unless, of course you attend Smith or other programs that somewhat, but not entirely utilize this approach. An 'I'm trying to be smart, clever.... i know what I'm talking about" feel seeps from the text. This was not helpful when switching back to her subjective experiences at McClain. It was taxing on a brain that had become use to a simple, more gentle way of approaching a rather difficult subject.

Another complaint was that it vividly portrayed someone who was struggling with BP and submitting to it, while later kicking against the diagnosis once released. This seemed to indicate someone who had not mastered her diagnosis, someone still mentally ill. Yes, she interjected a chapter here and a chapter there obsessing over the time-line of events that lead to her institutionalization, however, this seemed to be more a result of her typical manifestations of paranoia (there was a franticness about it), rather than a rational discussion of her mental illness. Consequently she also did a fairly nice job of exploring the mental health community, both in being so easily locked up in the 60s, as well as the questionable criteria used to do so; this topic, though was held on the sidelines, echoed through her rejections of her situation, and not intentional.

She did admit herself to Mclean's hospital (the argument that she didn't know this wasn't a choice is suspect), though, so there is that emptiness and boredom manifesting in her behaviors. However a chapter towards the end, titled 'Borderline Personality Disorder' she fought tooth and nail against the DX (note, this is an older configuration of symptoms), while she provided examples to the contrary, and also portrayed someone who exemplified the symptom list. I'll admit that it's a very female oriented list, and that its onset does start at the tail end of adolescence (18-24), but there exists extensive empirical evidence to support this list, and taken at its entirety it describes someone who doesn't adhere to normative, culturally specific behaviors—arguments and positions abound in this chapter as well as in the general public regarding the conformity aspect... I GET IT, I do.). The act of submitting to ones DX to the sudden, delayed rant that she didn't have it, was out of context with the rest of the book, and just came off whiny and argumentative.

You get a pass here—a little bitty one—Ms Kaysen, because, after all personality disorders are here to say, and they very much suggest a flawed person. However, until you get your shit together and accept the idea, and possibly (HOPEFULLY) the work needed to charge against this DX, I have to have my own judgements; you understand, don't you?


Yet, the chapters on the other residents of Mclean hospital—a mecca of mental health care and still the best in the country, even though Alex Beam, in his faulted book 'Gracefully Insane: The Rise and Fall of America's Premier Mental Hospital' provides 'evidence to the contrary'; as faulty as it may be—were astute, clear, and precise. As a reader I really got inside the heads of these characters. One problem for me is that she seemed to respect them as equal, however towards the end, post hospitalization, the ugly head of bitter analysis raised its teeth and started chomping. In all, though, these chapters—which were the majority of the work—were the glue of the book, binding the rest of the ill constructed portions that should have been omitted.

This book is like wading in the water of mental illness. you question your life, compare yourself to others, and as Kaysen wrote, begin the process of deconstructing your own propensity to fall over the ledge into insanity—I use this term not to degrade mental health, but as a term used in the general public and throughout the text—. Questioning your own mental health, or the idea that you too may wet your toes in the vast cavern of mental illness, is something you will do while reading, and after you read "The girl at her music sits in another sort of light, the fitful, overcast light of life, by which we see ourselves and others only imperfectly, and seldom."; the last sentence of the book. Folding back the pages, putting it next to your other books, or returning it to the library you are, either unconsciously or consciously going to question your own mental status. But maybe this is a good thing. Maybe we should always question our individual grasp on reality, our interpretation of the chest of drawers (tiger or Ikea cardboard?), because, after all, it will either confirm—prove we are functioning normally (for now)”, or disprove this fact.



caveat: Lets be clear here, however, other than defense mechanisms this analyst, Feud crap has been shelved for CBT, solution focused therapy, as well as DBT (this one specifically).


Why did she do it? Nobody dared to ask. Because - what courage! Who had the courage to burn herself? Twenty aspirin, a little slit alongside the veins of the arm, maybe even a bad half hour standing on a roof: We've all had those. And somewhat more dangerous things, like putting a gun in your mouth. But you put it there, you taste it, it's cold and greasy, your finger is on the trigger, and you find that a whole world lies between this moment and the moment you've been planning, when you'll pull the trigger. That world defeats you. You put the gun back in the drawer. You'll have to find another way.

What was that moment like for her? The moment she lit the match. Had she already tried roofs and guns and aspirins? Or was it just an inspiration?

I had an inspiration once. I woke up one morning and I knew that today I had to swallow fifty aspirin. It was my task: my job for the day. I lined them up on my desk and took them one by one, counting. But it's not the same as what she did. I could have stopped, at ten, or at thirty. And I could have done what I did do, which was go onto the street and faint. Fifty aspirin is a lot of aspirin, but going onto the street and fainting is like putting the gun back in the drawer."


Suicide is a form of murder premeditated murder. It isn't something you do the first time you think of doing it. It takes some getting used to. And you need the means, the opportunity, the motive. A successful suicide demands good organization and a cool head, both of which are usually incompatible with the suicidal state of mind.

It’s important to cultivate detachment. One way to do this is to practice imagining yourself dead, or in the process of dying. If theres a window, you must imagine your body falling out the window. If there's a knife, you must imagine the knife piercing your skin. If there's a train coming, you must imagine your torso flattened under its wheels. These exercises are necessary to achieving the proper distance.

The debate was wearing me out. Once you've posed that question, it won't go away. I think many people kill themselves simply to stop the debate about whether they will or they won't. Anything I thought or did was immediately drawn into the debate. Made a stupid remark "why not kill myself? Missed the bus, better put an end to it all. Even the good got in there. I liked that movie”maybe I shouldn't kill myself.

In reality, it was only part of myself I wanted to kill: the part that wanted to kill herself, that dragged me into the suicide debate and made every window, kitchen implement, and subway station a rehearsal for tragedy.


Don't separate the mind from the body. Don't separate even character - you can't. Our unit of existence is a body, a physical, tangible, [...] entity with perceptions and reactions that express it and form it simultaneously.


Disease is one of our languages. Doctors understand what disease has to say about itself. It's up to the person with the disease to understand what the disease has to say to her."