From Girl to King: Borderline Personality Disorder

by Anikain Mental Health in the Movieson Posted on

This review is part of my Mental Health in the Movies project and is a discussion of the film(s) portrayal of psychopathology and/or psychotherapy.

Girl, Interrupted (Columbia Pictures, 1999) and The King of Staten Island (Universal Pictures, 2020) were released two decades apart. Thematically, they both center a young adult suffering from a mental illness that manifests itself as a self-destructive ambivalence of ambition and confused identity due to trauma. But the details of their stories are significantly different. The differences and similarities are interesting to look at from the lens of gender, of space, and of time. 

Both Susanna and Scott, the respective protagonists of Girl, Interrupted and The King of Staten Island, suffer from Borderline Personality Disorder (BPD). Girl, Interrupted is based on the memoir of the same name by Susanna Kaysen. Kaysen published some of her medical records in the book and the film includes a scene where Susanna and her peers break into their psychiatrist’s office to read them. Susanna’s diagnosis is explicit and the diagnostic criteria of BPD is a part of the script. This is not the case in The King of Staten Island. Scott receives no treatment for or diagnosis of his mental illness. However, the film is semi-autobiographical and Pete Davidson, who portrays Scott and co-wrote the screenplay, was diagnosed with BPD. On screen, both Susanna and Scott fit the DSM5 diagnostic criteria of BPD, and the personal description of BPD in Merri Johnson’s memoir Girl in Need of a Tourniquet, particularly in their relationships and sense of self. For example:

Frantic efforts to avoid real or imagined abandonment. + “The poem consisted of two words. LOVE ME.” Scott’s fear of abandonment stems from his father’s death, and his sister leaving for college is an inciting incident in the film. Susanna clings to relationships. 

A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. + “I GOT SICK OF MYSELF. I WANTED ME TO MOVE OUT TOO.” Susanna has a string of unhealthy relationships. She had sexual relationships with one of her father’s colleagues, a married man twice her age, and a peer who offers to break her out of the hospital so she can join him in running from the draft. She successfully seduces an orderly in the hospital and antagonizes the nursing staff. And she befriends Lisa, another patient, who is described as sociopathic and portrayed as dangerous and unstable. In each case, Susanna veers between adoring and despising them. 

Scott has an unstable relationship with his on again/off again girlfriend whom he both leans on and pushes away. He is close to his mother and his sister and they are both exhausted by his needs and moods. He has an antagonistic relationship with his mother’s new boyfriend, Ray, up to and including a fight in the backyard that results in his mother throwing them both out of her life— at which point Scott essentially moves in with Ray and his firefighter friends. 

Identity disturbance: markedly and persistently unstable self-image or sense of self. + “I tend to veer off the road. I tend to overcorrect.” Early in the film, Susanna asserts that she wants to be a writer. Clearly, the real Susanna Kaysen succeeded in her goal but in both film and memoir her ambition is scoffed at as improper and frivolous. Scott’s desire to be a tattoo artist is treated to the same disdain. It’s interesting that both Susanna and Scott have some sense of who they want to be but it is not supported by their community, and the result is a more unstable sense of identity. 

Susanna and Scott both also conform their identities to how people treat them. While hospitalized, Susanna acts out and embraces ‘crazy’ until a nurse calls her out on it. Scott accepts that he is stupid until he’s assumed to be a normal college student at a party. They believe what they are told because they have an ill formed sense of self. 

Impulsivity in at least 2 areas that are potentially self-damaging./Recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour./Inappropriate, intense anger or difficulty controlling anger. + “I could so easily have set a house on fire. I could so easily have found myself behind bars.” Both Scott and Susanna are suggested to self-harm. Scott drives recklessly and Susanna has sex with multiple inappropriate partners. Both have fits of intense anger. Susanna attempts suicide and Scott narrowly avoids jail. 

Chronic feelings of emptiness. + “”It will get better,” she promises. “You won’t always feel this way.” I smile, nod, and stand to leave, but secretly I don’t believe her.” Both Susanna and Scott show signs of depression and a lack of direction. They are wandering through life, seeking something to make them feel real.

Historically, BPD was considered more common in women, to a ratio of 3:1. More recently this statistic has been interrogated from the perspective of gender norms and gender bias in the treatment of mental illness. In “BPD: mental illness or misogyny?” Gillian Proctor asserts that “The BPD diagnosis is used to label those women whose feelings and behaviours do not meet the standards of ‘normality’ and ‘acceptability’ for women.” The paper “Gender Differences in the Treatment of Patients With Borderline Personality Disorder” suggests “the steep gender gap in diagnosed BPD reflects a gender bias in diagnostic procedures”, that “men are known to seek less health care services for mental health problems compared to women”, and that “men with BPD enter into other treatment systems where they are less likely to be diagnosed with the disorder, such as criminal justice settings”. Girl, Interrupted and The King of Staten Island are gendered stories, and the points of view in these papers are included in the films.

Susanna is eighteen years old when she enters the psychiatric hospital. She is a very young adult and may reasonably be identified as a ‘girl’. However, the title of the film infantilizes her and her peers in the hospital before it even starts. She is also immediately contrasted with the young women she graduated high school with in the opening scenes of the film. Susanna is the only one not going to college, the only one not following society’s playbook for women of her class. Susanna’s mental illness has interrupted the timeline set for her. Likewise, Scott not only didn’t go to college, he dropped out of high school. Scott is also older than Susanna, twenty-four, but his younger sister takes care of him, and he has an easier time relating to children than adults. The title of his film, however, elevates him from ‘boy’ to ‘king’. The films suggest that society and/or community allow men more time to find themselves and more time to fail.

Susanna has greater access to both diagnosis and care. This is due to a combination of factors. One, she is of a higher socioeconomic class. Scott’s family is working class; his father was a firefighter who died on the job when he was seven, and his mother is an emergency room nurse. Susanna’s father is a professor at MIT and her family lives comfortably in Cambridge, Massachusetts (median income $112,565). Scott and his sister were raised by a single mother in Staten Island (median income $69,021). Two, Susanna’s parents actively seek diagnosis and psychiatric confinement for their daughter and Susanna goes along with it. Women are more likely to seek treatment for mental health care. While the hospital is not what Susanna initially wants, she ultimately accepts treatment. Despite the established trauma of losing his father as a child and the clear evidence of a struggle with mental illness, no one in Scott’s life specifically suggests therapy, though he is on antidepressants. Three, Susanna attempts suicide. Scott’s behavior is reckless but he only threatens to hurt himself, he doesn’t act on it. Susanna is also considered promiscuous and outspoken, behaviors that are seen as inappropriate in women, particularly in the 1960s, but normal in men.

“Girl, Interrupted: The Book and the Film”, a review by a medical doctor and professor of psychiatry, suggests that “By today’s standards, it is highly unlikely that Ms. Kaysen would be hospitalized.” Psychiatric care in 2000, when the review was written, was less institutional than in 1967, when Susanna was sent to McLean Hospital for eighteen months. In 2000 and in 2023, Susanna’s therapy and medication management would be outpatient. The King of Staten Island includes a robbery subplot where Scott’s friends convince him to participate as their lookout while they steal oxycodone from a pharmacy. Scott fails to raise the alarm for his friends and they are arrested while he flees. As mentioned earlier, many men, particularly those of a lower socioeconomic class, only receive psychiatric care when they enter prison. Thus Scott’s lack of intensive treatment is seemingly more realistic to the present than Susanna’s extensive treatment.

But Scott’s lack of treatments is perhaps most clearly attributed to fear. He tells Kelsey “All right, can I just tell you…can I tell you something? But can you, like, not tell anybody? Well, people probably know, but, like…There’s, like, something wrong with me. Like, mentally, like….Like, I’m not okay up there. You know? Like…I-I get all mad, acting, like, crazy, and I, and I make really insane, impulsive decisions.” The way the scene plays, it’s suggested he’s telling her this to break things off with her. But it is also very revealing. Scott feels like there is something deeply wrong with him, something overwhelming and scary. He doesn’t want to be that way, but he’s afraid for anyone to know. Even though he also believes they already know. Scott, and everyone in his life, knows he needs help but doesn’t know how to deal with it. The result is his girlfriend turns him away, his sister leaves, and his mother throws him out, all to focus on themselves. Still, because of stigma and access, no one suggests psychiatric intervention. 

Susanna’s stay in the hospital is contrasted with Scott’s stay in the firehouse. Susanna is sent to the hospital and required to remain until she is considered healed by psychiatric authorities. Scott chooses to seek out Ray and his friends and the expectation is that he will leave as soon as possible. But in both cases they believe that they have nowhere else to go, and ultimately they both find a community and sense of belonging. Interestingly, Susanna has to turn her back on the community she discovers with her peers in order to be healed and released. Scott’s situation is improved by embracing the community the firehouse offers him. Both are required to conform to standards of society — Susanna through therapy, Scott through completing chores— but Scott is allowed to keep his new friends and connections. 

The King of Staten Island is a more comforting portrayal of mental illness. Girl, Interrupted includes horror elements to sell its story as scary and unattractive. The hospital is portrayed as antiseptic, unfriendly, boring, and frightening. All of the patients are stuck and pitiable, their lives ‘interrupted’ by their illness. They must be kept separate and hidden from the rest of society lest they infect it. Susanna is described as too healthy for the hospital and accused of pretending to be crazy, as if mental illness is something that can be turned on and off at will. Daisy’s suicide, Polly’s perpetual imprisonment, and Lisa’s breakdown in the final scenes portray mental illness as often inescapable. Susanna gets out because of her work ethic and willingness to disavow mental illness as an identifier.

Like Susanna, Scott is in a better place at the end of his film than the beginning of it. But he is helped through an acknowledgement of the struggle. He learns that his father was impulsive and reckless and likely also suffered from an undiagnosed mental illness. He acknowledges that he’s made life more difficult for his mother, his sister, and his girlfriend and he strives to do better. In Girl, Interrupted, Susanna escapes her BPD while in The King of Staten Island, Scott learns to better manage it. In this way, The King of Staten Island is a kinder and potentially more realistic portrayal of mental illness, especially in the modern era. However, the lack of any on screen representation of mental healthcare keeps it from truly de-stigmatizing treatment. 

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