Girl, Interrupted

Paloma Garcia Duran

and Kali Robinson

Synopsis
Susanna Kaysen is a 18-year-old writer who seems to have trouble fitting in and often turns to promiscuous activity to feel her loneliness. Immediately it is
revealed to the audience that she has a rebellious past, including a secret affair she had with a professor. Upon high school graduation Susanna finds out that
she would be the only student in her graduating class not graduating and attending college. Following what appears to be a suicide attempt with an overdose of
aspirin and vodka, she is shipped to Claymore hospital for observation. Here she befriends Polly (schizophrenic childlike burn victim), Georgina (a
pathological liar), Daisy (pampered bulimic), Janet (anorexic), and Cynthia (mentally disturbed lesbian). Most of all she finds herself enchanted with one
particular patient named Lisa Rowe. Lisa is diagnosed as a sociopath and often takes pleasure in mocking and manipulating others to get what she wants. Lisa
convinces Susanna to stop taking her medication, sneak out of their room together, and resist therapy. One night the group of women sneak into the psychiatrist
office to read their folders. Within Susannas folder, it is revealed to the audience that she is diagnosed with Borderline Personality Disorder. One night Lisa
slips a pill into the mouth of the sleeping orderly to escape from the hospital, and Susanna seduces another orderly to keep him from reporting them. After
being caught with the acts, Nurse Valerie refers them to a therapist. After Lisa does not return, Susanna falls into a deep depression. Frustrated with Susanna's
noncompliance, Valerie throws her into a cold bath to give her a reality check and states to Susanna that she is not crazy, just a "lazy, self-indulgent little girl
who is driving herself crazy." That night Lisa returns and convinces Susanna to sneak out of the hospital and go stay with the newly released Daisy. Here Lisa
viciously accuses Daisy of enjoying a incestuous relationship with her father and pushes her to her maximum breaking point. Although Susanna expresses
anger toward Lisa, she was not able to stop her from verbally attacking Daisy. In the morning, Susanna discovers Daisy dead. Distraught by the vision of her
dead friend, Susanna returns to the hospital. Once she returns, she stops feeling sorry for herself and cooperates with her doctors. With Susanna seemingly
healthier, she is scheduled to be released. On her last night at Claymore, Susanna awakens to discover Lisa reading her stolen diary aloud to Georgina and
Polly, including all of her personal thoughts and private comments Suzanna has made about them to try and get Georgina and Polly to turn against Susanna.
Here Susanna finally sticks up for herself against Lisa, and is no longer under her spell. The next day she is released back into society as a recovered
Borderline.

Essential Characters
Susanna: main character diagnosed with borderline personality disorder.
Lisa: patient diagnosed with sociopathy that becomes close to Susanna.
Daisy: patient with compulsive eating disorder who is sexually abused by
her father; her suicide reveals to Susanna how dangerous Lisa can be.
Valerie: African-American RN gives Susanna reality checks about her
problems.
Professor Gilcrest: married man that had an affair with Susanna.
Mrs. Kaysen: Susannas mother, who represents the type of woman
Susanna does not want to become.

Essential Characters
Lisa:
patient
diagnosed
with
sociopathy
that
becomes
close
Susanna.
Valerie:
Susanna:
Daisy:
Professor
patient
African-American
main
Gilcrest:
with
character
married
compulsive
diagnosed
RN
man
gives
eating
that
with
had
Susanna
disorder
borderline
an affair
reality
who
with
personality
istype
checks
sexually
Susanna.
about
disorder.
abused
her
by her
Mrs. Kaysen:
Susannas
mother,
who
represents
the
of to
woman
Susanna
father;
problems.
herwant
suicide
reveals to Susanna how dangerous Lisa can be.
does not
to become.

Non-Essential Characters

Georgina: Susannas roommate, suffers from compulsive lying disorder (pseudologia

fantastica).
Janet: patient with anorexia nervosa.
Polly Torch: burn victim.
Cynthia: patient diagnosed as a lesbian.
Toby: Susannas boyfriend with whom Susanna performs oral sex during a visitation and he
tries to make her escape from the psychiatric hospital.
Travis: orderly who likes Susanna and kisses her.
Mrs. Gilcrest: professors wife who confronts Susanna in the ice cream shop.
Miss Gilcrest: Susannas former classmate.
Dr. Wick: psychiatrist.
Dr. Potts: psychiatrist who is friend of Susannas family.
Carl Kaysen: Susannas father.

Communication Techniques
Therapeutic
Susanna: Get me out of here!
Valerie (RN): Get yourself out!

Susanna: What are these (refers to medication)?

Nurse: They help you sleep.
Susanna: I, uh, don't need these.
Nurse: Are we gonna have a problem?

Dr. Wick: Is there something about sex which lifts

your feelings of despair?

Susanna: I didn't try and kill myself!

Dr. Potts: You chased a bottle of aspirin with a bottle
of vodka.
Susanna: I... had a headache...
Dr. Potts: Laughs

Susanna: Have you ever had sex?

1.

Non-Therapeutic

Focus on pts responsibility and suggest alternative methods of coping with situation.
Valerie encourages Susanna to take responsibility of her actions and take control of
the situation instead of waiting to be helped.

2.

Dr. Wick uses open-ended statements maintaining a nonjudgmental attitude. Lisa

response is not therapeutic because does not answer the question, changes topic, and
maintains a judgmental attitude.

3.
4.

Non-therapeutic because nurse threatens the pt to take the medication.

Non-therapeutic because Dr. laughs at pts response. However, if not maintaining that
burlesque attitude, You chased a bottle of aspirin with a bottle of vodka. would be a
therapeutic response because therapeutically confronts the pt with the facts of what
happened without judgment.
(Halter, 2014, pp. 154-157, 470)

Inappropriate Behaviors

Hooking up with the orderly

Not taking medications (holding them after being given)

Sharing medications

Hooking up with boyfriend in bedroom

Leaving room and roaming the hospital

Breaking into the office to read files

Escaping the hospital

Lisa tempting the ice cream worker

Screaming in the ice cream store

Nursing Diagnosis and Interventions

Nursing Dx: Risk for suicide r/t history of prior suicide attempt with aspirin and
alcohol overdose.

Goal: refrain from harming self.

(Ackley & Ladwig, 2014, pp.778- 779)

Nursing Interventions
1.
2.

The nurse will assess the clients ability to enter into a no-suicide contract.
The nurse will be alert for warning signs of suicide:

3.
4.
5.

I cant go on
Nothing matters anymore
Being suddenly happy and calmed

The nurse will determine the presence and degree of suicidal risk.
The nurse will develop a positive therapeutic relationship with the clients.
The nurse will verify that the client has taken medications as ordered by conducting
mouth checks after medication administration.
(Ackley & Ladwig, 2014, pp. 778- 782)

Rationales:
1.
Discussing feelings of self-harm with a trusted person provides relief for the client. A contract
gets the subject out in the open and places some of the responsibility for safety with the client.
Some clients are not appropriate for a contract: those under the influence of drugs or alcohol or
unwilling to abstain from substance use, and those who are isolated or alone without assistance
to keep the environment safe. If the client will not contract, the risk of suicide should be
considered higher. Although contracting is a common practice in psychiatric care settings,
research has suggested that self-harm is not prevented by contracts. Thorough, ongoing
assessment of suicide risk is necessary, whether or not the client has entered into a
no-self-harm contract. Contracts may not be appropriate in community settings.
2.
Suicide is rarely a spontaneous decision. In the days and hours before people kill themselves,
clues and warning signs usually appear.
3.
Using the acronym SAL, the nurse can evaluate the clients suicide plan for its Specificity
(how detailed and clear is the plan?), Availability (does the client have immediate access to the
planned means?), and Lethality (could the plan be fatal, or does the client believe it would be
fatal?). Assessment of reasons for living is another important part of evaluating suicidal clients.
4.
Be aware that some clients may offer to self-disclose if the nurse will promise not to tell
anyone what they have said. Clarify with the clients that anything they share will be
communicated only to other staff but that secrets cannot be kept. Nurses reconnect suicidal
clients with humanity by guiding the client, helping them learn how to live, and helping them
connect appropriately with others. Positive support can buffer against suicide, whereas
conflictual interactions can increase suicide risk.
5.
The client may attempt to hoard medications for a later suicide attempt.
(Ackley & Ladwig, 2014, pp.778- 782).

Borderline Personality Disorder

Most well known and dramatic of the personality disorders. Characterized by:

Severe impairments in functioning

Emotional lability
Impulsivity
Identity or self-image distortions
Unstable mood
Unstable interpersonal relationships
(Halter, 2014, p. 471)

Feelings of emptiness
An inclination to engage in risky behaviors such as reckless driving, unsafe
sex, substance use, binge eating, gambling, or overspending
Intense feelings of abandonment that result in paranoia or feeling spaced out
Idealization of others and becoming close quickly
A tendency toward anger, sarcasm, and bitterness
Self-mutilation and self-harm
Suicidal behaviors, gestures, or threat
Sudden shifts in self-evaluation that result in changing goals, values, and career
focus
Extreme mood shifts that occur in a matter of hours or days
Intense, unstable romantic relationships
(Halter, 2014, p. 472)

Medications

Anxiolytics

Antidepressants

Mood-stabilizers

Low-dose antipsychotics

Omega-3 supplementation
(Halter, 2014, p. 476)

In the United States, there are no medications specifically approved by the FDA for treating
personality disorders. This means that prescribers are using the medications off label until
evidenced-based pharmacotherapies are proven to be safe and effective. Psychotropic
medications geared toward maintaining patients' cognitive function, symptom relief, and
improved quality of life are available. Persons with borderline personality disorder often
respond to anticonvulsant mood-stabilizing medications, low-dose antipsychotics, and
omega-3 supplementation for mood and emotion dysregulation symptoms. Naltrexone, an
opioid receptor antagonist has been found to reduce self-injuring behaviors.
(Halter, 2014, p. 476)

Medications for Susanna

Mood stabilizer: valproic acid (Depakene) 750 mg BID PO

Side effects: drowsiness/dizziness, hepatotoxicity, bruising and bleeding, GI symptoms, skin

rash, hyperammonemia, pancreatitis, BMS. Neural tube defect in fetus.
Nursing considerations: take exactly as directed. Abrupt withdrawal may lead to status
epilepticus. Avoid alcohol and other CNS depressants when taking this medication. Administer
with food if GI effects occur. Monitor CBC with differential, LFT, amylase, lipase, and serum
drug levels. Assess and monitor seizures.

(Kizior, Hodgson, Hodgson & Witmer, 2015, pp. 1247-1249)

Medications for Susanna

Antipsychotic: olanzapine (Zyprexa) 10 mg/day PO

Side effects: neuroleptic malignant syndrome, seizures, suicidal thoughts, agranulocytosis.

Nursing considerations: Report abnormal muscle movements or seizure to HCP. May cause
drowsiness so avoid alcohol and CNS depressants. Monitor pts mental status, BP, ECG, CBC,
and LFT. Monitor for development of NMS. Refer if EPS occur.

(Kizior, Hodgson, Hodgson & Witmer, 2015, pp. 709-713)

Medications for Susanna

Antidepressant: fluoxetine (Prozac) 20 mg/day PO

Side effects: agitation, insomnia, headache, nausea and vomiting, sexual dysfunction, weight
gain, risk for suicide, and hyponatremia.
Nursing considerations: take this medication exactly as directed. Abrupt stop of medication
produces discontinuation syndrome (dizziness, insomnia, increased BP, fever, nervousness, and
cardiovascular symptoms). Avoid other depressants such as alcohol and St. Johns wort. Report
chest discomfort, palpitations, or suicidal thoughts immediately. Assess for suicidal tendencies,
especially in the first 2-4 weeks. Monitor appetite and nutrition intake. Monitor CBC, LFT, and
RFT.

(Kizior, Hodgson, Hodgson & Witmer, 2015, pp. 878-880)

References

Past Posters. (2015). Girl, Interrupted Poster. Retrieved from http://www.pastposters.com/details.php?prodId=4585

Crackle Movies & Television. (2011, November 20). Girl, Interrupted - Trailer [Video file]. Retrieved from
https://www.youtube.com/watch?v=5BHHUBZf7y4

Ackley, B. J. & Ladwig, G. B. (2014). Nursing Diagnosis Handbook: An Evidenced Based Guide to Planning Care, (9th
ed.). St. Louis, MO: Mosby Elsevier. VitalBook file.

Halter, M. J. (2014). Varcarolis' Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, (7th ed.).
Saunders Company. VitalBook file.

Keep Calm O-matic. (2014). Thanks for your attention & any questions? image. Retrieved from
http://www.keepcalm-o-matic.co.uk/p/thanks-for-your-attention-any-questions-10/

Kizior, R., Hodgson, B., Hodgson, K., & Witmer, J. (2015). Saunders Nursing Drug Handbook 2015, (23rd ed.). Saunders
Company. VitalBook file.