Themes are the fundamental and often universal ideas explored in a literary work.
Kaysen carefully skirts around the issue of whether she was ever truly ill. Her ambiguity exposes one of the central themes of the memoir: the line between sane and insane, normal and deviant is a blurry one. More importantly, it is a distinction that, except in the most desperate instances of mental illness, scarcely captures the personality it seeks to classify. The distinction between “normal” and “crazy” can be so fine, she argues, that our insistence on making it is shortsighted at best. After all, even in the case of the demonstrably insane, “is a nonreality-recognizing brain truly as different from a reality-recognizing brain as a foot, say, from a brain? This seems unlikely. Recognizing the agreed-upon version of reality is only one of billions of brain jobs.”
Kaysen confronts her diagnosis as a borderline personality line by line, making its imprecision clear. Charged with “uncertainty about long-term goals,” “instability of self-image,” and “social contrariness,” Kaysen wonders whether every teenager might satisfy these classifications. She admits to having been a troubled adolescent, behaving rebelliously and rejecting the goals set out for her by parents and the educational system. Yet these behaviors were clearly not predictive of her adult life. Early in the memoir, Nobel laureate James Watson visits Kaysen on the ward. She describes her warm feelings for him, derived primarily from Watson’s refusal or inability to follow social convention. His eccentricity does not impede his powerful intellect.
In several instances, Kaysen admits to self-destructive behavior during adolescence and seems to concede that she was clinically ill. In her portrayals of Alice, Daisy, and Polly, however, she presents examples of people truly incapacitated by mental illness, juxtaposing their predicaments with her own and others’. She argues that a point exists at which people require treatment, hospitalization, and even isolation from others. Yet we are far too quick to pass this kind of judgment. Her two-year confinement, and the consequences that resulted from it, convinced Kaysen of our profound need to define people within conventional social norms. The costs of those decisions are high.
When Kaysen enters McLean Hospital, she quickly comes to understand that although captivity appears to require the surrender of freedom, the opposite is often true. The ward is organized to keep patients exposed to staff scrutiny at all times. With nurse checks at frequent intervals, every room is essentially public except for one. The “seclusion room” sits at farthest reach of the main hallway, intended for out-of-control patients who pose harm to others or simply make too much of a disturbance. Patients can also choose to be placed in the room, prompting Kaysen to remark, “freedom was the price of privacy.” Here, a patient can be blessedly alone for a period, free from scrutiny and company but confined to even tighter quarters. The seclusion room is a microcosm for the entire experience of confinement to the hospital. Kaysen notes that McLean is “a refuge as much as a prison.” Without school, a job, bills, parents, or the outside world to deal with, the girls are free to ignore responsibility, even as that responsibility has been taken from them. Kaysen finds that this apparent paradox isn’t confined to the hospital. After nearly two years at McLean, Kaysen looks for a means to leave but finds that her hospital stay stigmatizes her in the eyes of employers. A marriage proposal turns her circumstances on their head. “Everyone could understand a marriage proposal,” she writes, despite nearly total uncertainty about the appropriateness of her fiancé or the appeal of marriage itself. The engagement frees Kaysen from the confinement of the hospital, but it limits her opportunities.
Women continue to face prejudice and discrimination today, but these phenomena were more overtly evident during Kaysen’s adolescence. She faces sexism of a crude kind in her typing job at Harvard, prior to entering the hospital. The supervisory staff is comprised entirely of men, and the typing staff is only women. Kaysen is bewildered by the obvious inequities she faces in the workplace. She is forced to obey a strict dress code and is particularly incensed by the fact that women are allowed to smoke only in the bathroom, on breaks. She faces job-related discrimination again when she tries to plot her life post-hospitalization. Counselors urge her into intellectually undemanding service jobs; she is startled when even Valerie, the confident head nurse, seems to nudge her in this direction. Only a marriage proposal, offering the most traditional kind of female role, saves her from becoming a dental technician. Sexism also appears in Kaysen’s diagnosis of borderline personality disorder. The illness, she tells us, is most commonly diagnosed in women, and the symptoms are almost universally identified in women. Shoplifting, compulsive shopping, binge eating, and promiscuity are not usually characteristics that are associated with compulsive male behavior. Although opportunities for women began to expand rapidly in Kaysen’s youth, American society was still full of the most vulgar of old-fashioned behaviors and prejudices.
Motifs are recurring structures, contrasts, or literary devices that can help to develop and inform the text’s major themes.
Confined to a hospital ward for the last two of her teenage years, Kaysen learns to value her ability to track the passage of time. She revisits several times her initial diagnosis by a doctor with whom she had never before consulted. Kaysen’s memory of the twenty-minute visit, surely not enough time to condemn a teenager to years of hospitalization, haunts her through adulthood. As an adult, she digs up hospital records to little avail: there are two competing accounts of the consultation. The vast disproportion of twenty minutes of discussion to two years of confinement still haunts her. On the ward, time is marked by the incessant “checks” made by nurses. Kaysen describes the five-minute, fifteen-minute, and half-hour checks as “murder[ing] time,” “chopping off pieces of it and lobbing them into the dustbin.” The pain of time lost in captivity is magnified by its never-ending and maddeningly predictable punctuation. Kaysen becomes obsessed with time, screaming at a dentist who has brought her out of general anesthesia, “it’s my time and I need to know how much it was! . . . I need to know.”
Kaysen argues that to commit suicide, one must practice detachment as a means of tricking the mind into destroying itself. Without the “proper distance,” she argues, the act is too heinous to be undertaken. Detachment is a familiar device for Kaysen and her fellow patients, a kind of armor they don to remove themselves from the reality of their sad plights. Even the constant assault of repetitive thought, a hallmark of mental illness in Kaysen’s conception, becomes “background music, a Muzak medley of self-hatred themes.” Detachment is most alarming when it reveals a person’s total inability to feel pain or pleasure. When Kaysen accidentally pours molten sugar on Georgina’s hand, Georgina has no reaction at all. Even searing pain can’t penetrate the shell of detachment Georgina has constructed to protect herself.
Kaysen’s adolescence coincides with the rise of late 1960s youth culture. Millions of baby boomers (i.e., children born at the end of the Second World War) came of age as teenagers and young adults. Older generations were startled by the abandonment of traditional cultural values by young people, whose unconventional appearance, music, antiwar protests, and psychedelic drug culture were totally alien to them. Kaysen believes that her doctor thought he was saving her from the “drifting, drugged-out, no-last-name youth universe” by placing her in a hospital. To her parents, Kaysen’s rejection of school achievement and a professional career were signs of mental disturbance, not the uncertainty of a teenager in confusing times. Kaysen describes Dr. Wick, one of the physicians at McLean, as “utterly innocent about American culture,” taken aback by frank discussion of sex. To the authority figures in her life, Kaysen and other people of her age were at great risk. The consequences of their confusion and fear for Kaysen were regrettable.
Symbols are objects, characters, figures, or colors used to represent abstract ideas or concepts.
Kaysen intersperses the essays in the book with copies of internal McLean Hospital records. These records represent what Kaysen describes as the “accurate but . . . not profound” nature of her doctors’ understanding of her problems. The records report Kaysen’s name, address, details of her suicide attempt, and other facts, but they provide little context and even less interpretation. The records are reminders of who she was and what she faced during those difficult years. The unreliability of the records becomes apparent when Kaysen discloses the contradictory accounts of her admission to the hospital.
The tunnels Kaysen discovers under McLean represent the “essence” of the hospital, stripped of its doors, bars, and signs. They reveal to Kaysen the nature of her own treatment. She understands, in the warm simplicity of the tunnels, that she and the doctors have been approaching her problems the wrong way, confused by “all the bother.” The tunnels, which allow access to every part of the hospital, grant Kaysen insight into her illness. She leaves the “shadowy” world of analysis behind to confront life on her own terms.