Manipulation and control, both institutional and interpersonal, are major thematic concerns for Susanna Kaysen as she brings her reader into the world of McLean. In recounting the ways in which she and her fellow patients were subjected to various forms of manipulation and control, day in and day out, during their stay on the psychiatric ward, Kaysen argues that such stringent manipulation and control of people already on the brink pushes them even further into their illness and pain, and possibly prevents them from recovering and reentering society as they hope to.
One of the most difficult things for Susanna to adjust to during her first few months in McLean is the concept of “checks”—checks carried out by nurses who open patients’ doors every five, fifteen, or thirty minutes in order to see what each patient is doing and assure no one is harming themselves or others. Checks “murder time” for Susanna, making her feel as if she is watching her life drip down a “drain” five minutes at a time. Checks are the “lullaby, metronome, [and] pulse” of the ward, and although she understands their necessity, Susanna sees the practice of “checks” as a way of preventing the women on her ward from experiencing, let alone savoring, their own lives. Another method of control which is supposedly for the good of the patients housed on the ward but contributes to the atmosphere of total control and lack of personal freedom is the rule against sharps, or any sharp objects that could be used to harm oneself or another. Women on Susanna’s ward who wish to shave their legs must do so while supervised by a nurse and are prevented from keeping personal objects such as nail files and earrings, and are even barred from using metal silverware at mealtimes. Though both of these restrictions are meant to minimize the amount of physical violence and self-harm that occurs on the ward, they represent the total control exerted over the lives of Susanna and her fellow patients, whose every movement is monitored. Kaysen makes the argument that it is perhaps this stringent environment which contributes to the lack of improvement, or even the worsening, of the symptoms she observes in many of the other women on the ward.
Therapists represent a major force of control and manipulation in Susanna’s life as a patient on the psychiatric ward. “They couldn’t grant or rescind privileges, help us get rid of smelly roommates, stop aides from pestering us,” she writes; “the only power they had was the power to dope us up.” The therapist who recommended Susanna for admission to McLean did so after meeting for her with only fifteen minutes. Susanna wonders if the therapist did so because he saw her as someone fragile and unstable who needed to be shielded from the outside world—a judgement that he, after such a brief meeting, was in no position to make. Though this therapist assured Susanna that she would only be staying in McLean for a couple of weeks, she ultimately wound up living there for eighteen months. This therapist, who barely knew Susanna at all, wound up changing a huge period of her youth, and completely transforming her life. Though Susanna is “fond” of her analyst, Melvin, she notes that he keeps saying “wrong things” about her. He has a preconceived idea of who Susanna is in his head, and is treating her according to that notion. When Susanna advances from therapy to analysis, she finds that her treatment consists of a lot of “messing about in the shadows”—constantly relaying her thoughts and feelings without receiving any real help, guidance, or advice as to how to process and navigate them. Dr. Wick, the head of Susanna’s ward, doesn’t offer Susanna anything much better in their therapy sessions. Edgy and easily embarrassed, Dr. Wick blushes at any mention of love or sex and judges Susanna and the other girls on the ward when they attempt to communicate honestly about their emotional and romantic histories. In this way Dr. Wick restricts the girls from being able to express certain aspects of themselves without being made to feel shame or censure.
When Susanna leaves McLean, she finds herself the victim of stigmatization and prejudice. In her last few months of treatment, she applies for several jobs, using the hospital’s infamous address—115 Mill Street—as her own on all her applications. After being rejected by employer after employer, Susanna realizes that one of two things is true each time: either someone in a position to hire her sizes her up and believes they already know her due to her hospitalization record, or they see her as “normal” and begin to wonder, if there’s no apparent difference between the “normal” Susanna and themselves, “What’s keeping me out of the loony bin?” In this way, Susanna’s mental illness—and the way others perceive her because of it—continues to place limitations on her.
Control is a major aspect of life in any health or wellness institution. Whether the treatment is for a mental or physical ailment, regimented control is, in theory, supposed to facilitate quicker, more meaningful, and more lasting healing. However, Kaysen argues that the controls and restrictions in place at McLean, coupled with a general lack of empathy, were symptomatic of deeper issues within mental healthcare in America at the time—issues that still exist today. The efforts of others to control and manipulate patients, Kaysen argues, only served to further mire her and her fellow patients in the labyrinths of their own minds, and prevented them from achieving self-understanding, self-acceptance, and self-actualization.
Related Themes from Other Texts
Manipulation, Restriction, and Control ThemeTracker
Manipulation, Restriction, and Control Quotes in Girl, Interrupted
An odd feature of the parallel universe is that although it is invisible from this side, once you are in it you can easily see the world you came from. Sometimes the world you came from looks huge and menacing, quivering like a vast pile of jelly; at other times it is miniaturized and alluring, a-spin and shining in its orbit. Either way, it can’t be discounted. Every window on Alcatraz has a view of San Francisco.
Take it from his point of view. It was 1967. Even in lives like his, professional lives lived out in the suburbs behind shrubbery, there was a strange undertow, a tug from the other world--the drifting, drugged-out, no-last-name youth universe--that knocked people off balance. One could call it "threatening," to use his language. What are these kids doing? And then one of them walks into his office wearing a skirt the size of a napkin, with a mottled chin and speaking in monosyllables. Doped up, he figures. He looks again at the name jotted on the notepad in front of him. Didn't he meet her parents at a party two years ago? Harvard faculty--or was it MIT? Her boots are worn down but her coat's a good one. It's a mean world out there, as Lisa would say. He can't in good conscience send her back into it, to become flotsam on the subsocietal tide that washes up now and then in his office, depositing others like her. A form of preventive medicine.
Swish, click. Before you knew it, she'd be back. Click, swish, "Checks," swish, click.
It never stopped, even at night; it was our lullaby. It was our metronome, our pulse. It was our lives measured out in doses slightly larger than those famous coffee spoons. Soup spoons, maybe? Dented tin spoons brimming with what should have been sweet but was sour, gone off, gone by without our savoring it: our lives.
Cynthia was depressive; Polly and Georgina were schizophrenic; I had a character disorder. Sometimes they called it a personality disorder. When I got my diagnosis it didn't sound serious, but after a while it sounded more ominous than other people's. I imagined my character as a plate or shirt that had been manufactured incorrectly and was therefore useless.
Therapists had nothing to do with our everyday lives.
"Don't talk about the hospital," my therapist said if I complained about Daisy or a stupid nurse. "We're not here to talk about the hospital."
They couldn't grant or rescind privileges, help us get rid of smelly roommates, stop aides from pestering us. The only power they had was the power to dope us up. Thorazine, Stelazine, Mellaril, Librium, Valium, the therapists' friends. Once we were on it, it was hard to get off. A bit like heroin, except it was the staff who got addicted to our taking it.
"You're doing so well," [our doctors] would say.
That was because those things knocked the heart out of us.
For many of us, the hospital was as much a refuge as it was a prison. Though we were cut off from the world and all the trouble we enjoyed stirring up out there, we were also cut off from the demands and expectations that had driven us crazy. What could be expected of us now that we were stowed away in a loony bin? The hospital shielded us from all sorts of things. We’d tell the staff to refuse phone calls or visits from anyone we didn't want to talk to, including our parents.
"I'm too upset!" we'd wail, and we wouldn't have to talk to whoever it was.
As long as we were willing to be upset, we didn't have to get jobs or go to school. We could weasel out of anything except eating and taking our medication.
In a strange way we were free. We’d reached the end of the line. We had nothing more to lose. Our privacy, our liberty, our dignity: All of this was gone and we were stripped down to the bare bones of our selves.
Valerie and Georgina picked me up under the arms and steered me down the hall to our room. My legs and feet felt like mattresses, they were so huge and dense. Valerie and Georgina felt like mattresses too, big soft mattresses pressing on either side of me. It was comforting.
"It'll be okay, won't it?" I asked. My voice was far away from me and I hadn't said what I meant. What I meant was that now I was safe, now I was really crazy, and nobody could take me out of there.
In the cab Valerie said, "I've got something for you." It was my tooth, cleaned up a bit but huge and foreign. "l snitched it for you," she said.
'Thanks, Valerie, that was nice of you." But the tooth wasn't what I really wanted. "l want to know how much time that was," I said. "See, Valerie, I've lost some time, and I need to know how much. I need to know."
Then I started crying. I didn't want to, but I couldn't help it.
He started asking me, "What are you thinking?" I never knew what to say. My head was empty and I liked it that way. Then he began to tell me what I might be thinking. "You seem sad today," he'd say, or “Today, you seem puzzled about something." Of course I was sad and puzzled. I was eighteen, it was spring, and I was behind bars.
In February I asked Melvin, "You know those tunnels?"
"Could you tell me more about the tunnels?" He didn't know about them. If he'd known about them, he would have said, "Yes?"
"There are tunnels under this entire hospital. Everything is connected by tunnels. You could get in them and go anywhere. It's warm and cozy and quiet."
"A womb," said Melvin.
"It's not a womb," I said.
"Yes." When Melvin said Yes without a questioning intonation, he meant No.
"It's the opposite of a womb," I said. "A womb doesn't go anywhere.”
[The mind is] full of claims and reasons. "You're a little depressed because of all the stress at work," it says. (It never says, "You're a little depressed because your serotonin level has dropped.")
Sometimes its interpretations are not credible, as when you cut your finger and it starts yelling, "You're gonna die!" Sometimes its claims are unlikely, as when it says, "Twenty-five chocolate chip cookies would be the perfect dinner."
Often, then, it doesn't know what it's talking about. And when you decide it's wrong, who or what is making that decision? A second, superior interpreter?
Why stop at two? That's the problem with this model. It's endless. Each interpreter needs a boss to report to.
The point is, the brain talks to itself, and by talking to itself changes its perceptions. To make a new version of the not-entirely-false model, imagine the first interpreter as a foreign correspondent, reporting from the world. The world in this case means everything out or inside our bodies, including serotonin levels in the brain. The second interpreter is a news analyst, who writes op-ed pieces. They read each other's work. One needs data, the other needs an overview, they influence each other. They get dialogues going.
I have a few more annotations to my diagnosis. 'The disorder is more commonly diagnosed in women." Note the construction of that sentence. They did not write, 'The disorder is more common in women." It would still be suspect, but they didn't even bother trying to cover their tracks.
Many disorders, judging by the hospital population, were more commonly diagnosed in women. Take, for example, "compulsive promiscuity." How many girls do you think a seventeen-year-old boy would have to screw to earn the label "compulsively promiscuous?” Three? No, not enough. Six? Doubtful. Ten? That sounds more likely. Probably in the fifteen-to-twenty range, would be my guess--if they ever put that label on boys, which I don't recall their doing.
And for seventeen-year-old girls, how many boys?
She had changed a lot in sixteen years. She was no longer urgent. In fact, she was sad. She was young and distracted, and her teacher was bearing down on her, trying to get her to pay attention. But she was looking out, looking for some- one who would see her. This time I read the title of the painting: Girl Interrupted at Her Music. Interrupted at her music, as my life had been, interrupted in the music of being seventeen, as her life had been, snatched and fixed on canvas: one moment made to stand still and to stand for all the other moments, whatever they would be or might have been. What life can recover from that?
I had something to tell her now. "l see you," I said.
