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Girl Interrupted

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by

Sinai Martinez

on 5 November 2013

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Transcript of Girl Interrupted

Personality Disorder
Ethical Concerns
Psychiatrist, family friend, manipulates Susana to sign herself into the facility.
Signing against her own acknowledgement of what was written, with no explanation.
Nurses fails to educate patient.
Patient and orderly sexual relations.
Physician sleeps while patient is in therapy session.


Nursing Interventions

Observe the client behavior frequently.
Secure a contract with the client that states that they will seek out a staff member when they feel the urge to self-harm
Have sufficient staff available to indicate a show of strength if necessary.
Convey an accepting attitude
Give meds as ordered
If client is not calmed by talking down or meds, restrains may be necessary.
Encourage them to talk about the feelings he or she was having right before the act.
The nurse also seeks to assist the client to advance in the development of personality by confronting his or her true source of internalized anger.
Act as a role model for appropriate expression of angry feelings, and
give positive reinforcement when attempts to conform are made.
Remove all dangerous items from clients environment
Redirect violent behavior with physical outlet

Persoality disorder
DSM-IV-TR definition: enduring patterns of perceiving, relating to, and thinking about environment and oneself that are exhibited in a wide range of social/personal contexts.
Traits become:
-Inflexible
-Maladaptive
-Significant functional impairment or subjective distress


The film chronicles the 2 year stay of Susanna Kaysen, a young girl diagnosed with Borderline personality disorder, who was sent to a renowned New England psychiatric hospital. During her stay she becomes captivated by a fellow patient named Lisa who was diagnosed with antisocial personality disorder. Together they stage a escape plan to reclaim their lives.

Girl, Interrupted
Nursing Interventions
IMPAIRED SOCIAL INTERACTION
• Help the client understand how these behaviors interfere with satisfactory relationships
• Help the client recognize these behaviors are occurring.
• Encourage independence and give positive reinforcement
• Rotate staff members to avoid over dependence
• Explore feelings of abandonment and fears
• Recognize when the client is using the defense mechanism of splitting and do not
acknowledge it.

RISK FOR SELF DIRECTED OR OTHER DIRECTED VIOLENCE
MAIN CHARACTER DESCRIPTION
Susanna Kaysen is 18 year old young woman who over doses on aspirin. She has short black hair and pale skin. Her dress is appropriate to situations and her mood and affect is generally depressed with the exception of her angry outbursts. She is seemingly depressed because she initially doesn’t know why she is the way she is. She becomes extremely angry at times towards people including her parents and the staff at the hospital. She has had multiple sex partners one being her high school teacher, but denies being promiscuous to her therapist. She does not want to go to college like the rest of her fellow high school class mates, and expresses to her therapist and her parents that she wants to become a writer. In the hospital she writes in her journal and gradually begins to write meaningful thoughts in journal.
SIGNS AND SYMPTOMS DISPLAYED
• Impulsivity (leaving the ward with Lisa on a whim, kissing an orderly)
• Irresistible urge to damage self (from suicide, to not wanting to go to college for no apparent reason)
• Feels threatened with loss of significant relationships ( Lisa was moved to another ward and she became very angry with the nurse saying that she is a black nurse maid)
• Suicidal ideation (expressed that she thinks about suicide so much )
• Suicidal plan (expressed a suicidal plan to her boyfriend Tobby)
• Fears of abandonment and childhood abuse (parents told her that they had to strap her to a board when she was a child)
• Internalized rage
• Depression
• Verbalizes feeling empty
• Inappropriate expression of anger (lashing out to the nurse singing a frantic song to seem “crazy” and then calling her a black nurse maid”)
• Alternating clinging and distancing behaviors (clinging to Lisa to the point that when they were separated she would not get out of bed. Distancing her parents and becoming very angry with them in family therapy)
• Manipulation of others (kissed staff member to let her have her way)
• Inability to be alone
• Splitting (describes self as ambivalent and the therapist clarifies that she has strong feelings of two opposing courses )

• Impulsivity (leaving the ward with Lisa on a whim, kissing an orderly)
• Irresistible urge to damage self (from suicide, to not wanting to go to college for no apparent reason)
• Feels threatened with loss of significant relationships ( Lisa was moved to another ward and she became very angry with the nurse saying that she is a black nurse maid)
• Suicidal ideation (expressed that she thinks about suicide so much )
• Suicidal plan (expressed a suicidal plan to her boyfriend Tobby)
• Fears of abandonment and childhood abuse (parents told her that they had to strap her to a board when she was a child)
• Internalized rage
• Depression
• Verbalizes feeling empty
• Inappropriate expression of anger (lashing out to the nurse singing a frantic song to seem “crazy” and then calling her a black nurse maid”)
• Alternating clinging and distancing behaviors (clinging to Lisa to the point that when they were separated she would not get out of bed. Distancing her parents and becoming very angry with them in family therapy)
• Manipulation of others (kissed staff member to let her have her way)
• Inability to be alone
• Splitting (describes self as ambivalent and the therapist clarifies that she has strong feelings of two opposing courses )

Was mental illness realistically portrayed?
The stereotype about mental illness

Personal frustration and confusion

Challenges in the treatments of adolescents

Typical pictures of the teenaged female in the media

Defense mechanism of denial

Denial of the illness by family members

Does the film increase or decrease the stigma about mental illness
DECREASE
The milieu in the movie Vs. how society believe it is

Patients were not violent towards staff

Phone calls

Ground privileges

Possibility for discharge.


NURSING INTERVENTION
Complicated Grieving
Create a trusting relationship
Encourage appropriate expression of anger
Explore true source of anger
Teach stages of greif
Set limits on acting out behaviors
Give positive feedback
Borderline Personality Disorder
A pattern of intense and chaotic relationships with affective instability and fluctuation attitudes toward other people
Borderline between neurosis and psychosis

Personality Characteristics
Depression
Inability to be alone
Clinging & distancing
Splitting
Manipulation
Self-destructive behaviors
Impulsivity

Predisposing Factors
Biochemical
Genetics
Child-hood trauma
Theory of object relations


Personality Disorder Treatment
Interpersonal Psychotherapy
Psychoanalytic Psychotherapy
Milieu/group therapy
Cognitive-behavioral therapy
Dialectical Behavior therapy
Psychopharmacology- SSRIs & MAOIs

Antisocial Personality Disorder
A “sociopathic or psychopathic” reaction that was symptomatic of any several underlying personality disorders.

Individuals with antisocial personality are seldom seen in most clinical settings

Characteristics
Socially irresponsible
Guiltless behavior
Manipulation
Difficulty sustaining consistent employment
Restless & easily bored
Seek thrill
Projection
Lack trust
Predisposing Factors
Temperament
Genetics
ADHD/ conduct disorder
Family dynamics

Treatment Results
Seclusion helped patients to calm down when irritable by lessening environmental stimuli, however, too much seclusion had a negative effect.
Sedatives helped the patients fall asleep easily.
Susanna was becoming increasingly depressed as time progressed, the cold baths were given to her to make her more alert.
After opening up to her therapist and seeing her three times a week, Susanna’s progressed occurred. In addition, she was off the medication, sleeping sound and no longer had any headaches.

Treatments used in the film
Seclusion
Ice-baths
Electroconvulsive Therapy (ECT)
Group therapy
Individual psychotherapy
Medications: Sedatives, laxatives

Emotional Reaction
It was a good movie that adequately portrayed the
mental disorders that it brought up. It was interesting to see the evolution of mental health from the 1960's to now. The actors were very dedicated to their character ad helped get the symptomotolgy across.
References
Girl, Interrupted. (1999)
Townsend, Mary C.. <i>Psychiatric mental health nursing: concepts of care in evidence-based practice</i>. 7th ed. Philadelphia: F.A. Davis Co., 2012. Print.
Full transcript