What does Kaysen’s inquiry into the meeting with the psychiatrist who diagnosed her tell us about her reliability as a narrator? What other conclusions can we draw?

At the outset of her memoir, Susanna Kaysen describes in great detail the consultation she had with the doctor who sent her to McLean Hospital. Later, she recalls that he spent only twenty minutes interviewing her before making a decision that would dominate her life for the following two years. For many chapters, we have no reason to distrust anything that Kaysen relays to us, from events in her life to the behavior of the people around her. In the middle of the book, however, Kaysen returns our attention to that initial meeting. She admits that, though she clearly recalls a twenty-minute conversation, hospital records indicate that the conversation lasted three hours. She retraces her steps that morning, questioning her memory, and concludes that the records may in fact be accurate. She unearths a second document, however, that supports her original point of view. “Do you believe him or me?” she asks in the chapter title.Kaysen confesses that she can be an unreliable narrator in order to illustrate the subjective nature of judgment. If hospital records, ostensibly the official version of events, can contradict each other, what else is called into question? Initial impressions can deceive, and so can memory. Kaysen admits to uncertainty about her meeting with the doctor in order to cause us to question the judgment of the authority figures in her story and ours. We should recognize that every story and conclusion is relayed through a subjective source.

Kaysen confesses that she can be an unreliable narrator in order to illustrate the subjective nature of judgment. If hospital records, ostensibly the official version of events, can contradict each other, what else is called into question? Initial impressions can deceive, and so can memory. Kaysen admits to uncertainty about her meeting with the doctor in order to cause us to question the judgment of the authority figures in her story and ours. We should recognize that every story and conclusion is relayed through a subjective source.

How do people react when Kaysen tells them of her hospitalization? How does she cope with their reactions?

Kaysen experiences considerable prejudice when she attempts to find a job. Her mailing address reveals her residence at McLean Hospital, and every potential employer seems to know it. Worse, she tells us, people seem to believe that they have some deep insight into her character simply by knowing that she was hospitalized. This “terrible intimacy” is unwarranted, of course, but Kaysen is acutely aware of other people’s judgment. She describes the curiosity she faces as a reflection of insecurity on the part of the questioner. Questions about her time at McLean disguise others’ fear of following the same path. In Kaysen’s mind, people fail to make a distinction between the person they see before them and familiar images of life in the “loony bin.” As a result, Kaysen begins to keep her experience at the hospital to herself. As she says, “there is no advantage in telling people.”

As she ages, Kaysen begins to feel that her younger, hospitalized self was an entirely different person. She internalizes the revulsion of others until it appears in her own behavior. The former patient now sees mental patients as others do.

What does the Lisa Cody episode reveal about Lisa? Does Kaysen judge Lisa for her actions?

At the outset of the chapter “Another Lisa,” Kaysen notes that the decision to call the new patient Lisa Cody was an easy one; the original Lisa “remained simply Lisa, like a queen.” Lisa enjoys a position of prominence on the ward—a role she takes great pains to protect. No one is ever as loud, funny, obnoxious, or daring as Lisa. She is particularly proud of her diagnosis of sociopath. It is a rare diagnosis and sets her apart from the mass of depressives, neurotics, and character disorders. At first, we see the kind, fun side of Lisa, who immediately befriends Lisa Cody, giving the new girl instant credibility on the ward. As soon as Lisa Cody is diagnosed as a sociopath, however, Lisa feels threatened and turns on her friend. A competition begins to determine the most troubled among them, the most scarred, and the most willing to shock. We understand at the outset that Lisa Cody’s prospects of winning this contest are poor; we’ve seen the lengths to which Lisa will go for attention. The rivalry turns dark when the two Lisas compare needle scars, competing for the title of “worst junkie.” Lisa Cody is embarrassed and soon leaves the ward. Later, Lisa returns from an escape to Boston to reveal that her efforts were rewarded: Lisa Cody is now a “real” junkie.

Kaysen’s narration is purposefully void of emotion or judgment. We know that the scenes and dialogue she creates are fictionalized to some extent. Kaysen allows her readers to draw their own conclusions. Lisa’s behavior is presented almost dispassionately. Kaysen has extensive experience with the consequences of pre-judgment, and so trusts her readers to make their own decisions.