Kaysen writes that it is perhaps still unclear to the reader exactly how she ended up in McLean. She wonders what was so “deranged” about her that a therapist who she’d never seen before decided to lock her up after less than twenty minutes. He told her she would only be in the “nuthouse” for two weeks, but in reality her stay was closer to two years. Thus, Susanna was only eighteen when she voluntarily committed herself on the advice of a man she barely knew at all.
Susanna, having admitted to feeling depressed, unstable, and suicidal, wonders what motivated a therapist who barely knew her—and did not take the time to get to know her—to recommend her for institutionalization rather than help her work through her problems on her own. She wonders what the therapist’s perception of her was, and how his shoddy, superficial concept of her informed his decision to place her in McLean.
Kaysen wonders if she was, at the time of her admittance, even in need of it, as she was not a danger to others or to herself. The fifty aspirin she took were a “metaphorical kind of self-abortion” meant to get rid of a certain part of her character, and she had “no heart” to try to commit suicide again.
Susanna maintains that while she had wanted to harm herself in the past, at the time of her admission to McLean she was not in danger of attempting suicide again. Thus, she believes that her institutionalization was something of an overreaction which served to derail her life.
Kaysen considers the therapist’s point of view. In 1967, even out in the suburbs, there was a “tug from the other world”—the counter-culture of the youth—that disrupted the status quo and baffled members of the older generation. Susanna posits that when she walked into his office, the therapist saw her as a “doped up” teen unable to survive in the “mean” world, and recommended her for admittance to McLean as “a form of preventive medicine.” Susanna then wonders if she is giving the therapist too much credit. A few years ago, she read he was accused of sexual assault by a former patient.
Susanna ultimately decides that her therapist’s decision to institutionalize her was based in many different factors. She believes her therapist saw her as an unstable woman who needed to be protected from the turmoil of the world through isolation, rather than taken seriously and given actual help in working through the very real issues which had arisen in her psyche. The sexual assault charges against him bolster Susanna’s argument for the therapist’s predatory, condescending, and dehumanizing view of women.
Kaysen writes that her own point of view is more difficult to explain—she went along with everything she was told to do. She visited the therapist for a consultation when she was told to, she got in a taxi when she was told to, she signed her freedom away when she was told to. Several preconditions, she writes, were necessary for her to go along with such a series of events.
Susanna knows that it must seem to her readers like she was completely passive and thus complicit in her own institutionalization, but Susanna argues that there was reason for her distance and removal from her own life.
Prior to her admittance, Susanna had been having problems with patterns—tile floors and printed rugs and curtains. She saw things inside of patterns, though she insists that she wasn’t hallucinating. She knew what she was looking at, but she couldn’t help but see the “potential representation” inherent within the patterns, and felt that her reality had become unbearably dense. Moreover, she was struggling with faces. When she was talking to someone and looking in their face, she dissociated their features from the face as a whole, and instead of seeing “too much meaning,” like in the patterns all around her, she couldn’t discern any from the other faces she encountered in her day to day life. She began to wonder if everyone around her thought the same way she did, and simply didn’t talk about it.
Susanna admits to having had fractures and splits in her perception in the months leading up to her hospitalization. Though she knew that what she was seeing wasn’t real, the overwhelming nature of these disconnects in her relationship to the world around her became difficult to deal with and negatively affected her quality of life. As she struggled to understand what was happening to her, she was made even more isolated by her need to know what “reality” was if everyone saw the world the way she did and just kept mum about it—or, on the other hand, what reality was if she was alone in her strange perceptions.
In response to these confusing feelings, Susanna became combative, and found integrity in saying “no” and denying herself basic needs and comforts. The chance to check herself into a mental institution, Susanna reveals, was the ultimate no: no to society, no to thriving, no to living in a mean and difficult and overwhelming world. Susanna admits that this was “perverse” reasoning, but also admits that she felt that because she was not truly insane, she would not be locked up for long.
Susanna reveals that her apparent passiveness in allowing herself to be shunted into institutional treatment was instead a conscious decision, and a choice to engage in contrarianism and defiance. She felt that because she was going into the hospital, in a sense, to “stick it to” those around her, she would not be there for long. However, she underestimated both the depths of her own problems and the rigidity and isolation of the McLean facility.
A scanned insert of one of Susanna’s hospital records reveals a fragment of her application for voluntary admission to McLean.
This fragment of paperwork punctuates Susanna’s tumultuous journey to McLean.