By Freddie deBoer
December 21st of 2024 marks the 25th anniversary of the release of the film Girl, Interrupted. The movie depicts a young woman named Susanna who finds herself, in the late 1960s, on a long stay in a psychiatric hospital – despite the fact that neither she, her parents, her fellow patients, nor her doctors are entirely sure she belongs there. Released in 1999, only ten days before the start of the new millennium, the film looks back at the much-romanticized 1960s with the same ambivalence that Susanna looks at her own mental health. Based on a widely celebrated 1993 memoir by the novelist Susanna Kaysen, the movie has been name-checked as an influence on many over the years since, most notably women writers and artists who had rarely seen their inner lives depicted on film.
Despite this, the moment of its anniversary has passed largely without comment. That’s not very surprising; the film has proven to be culturally influential, at least in certain circles, but it was a box office disappointment that received largely middling reviews. The film was a passion project for Winona Ryder, who both starred in the film and served as a producer. She in fact wrestled control of the movie rights away from several other industry figures before the book had even been officially published, eager to move onto more adult and serious material as an actress, even if that entailed portraying an 18-year-old as a 28-year-old. Girl, Interrupted ended up as a respected but ultimately minor film that did wonderful things for an ambitious actress’s career – just not Ryder’s. But we’ll return to that.
The movie’s muted reputation can perhaps be explained by its release in an extremely crowded year for the movies. Girl, Interrupted was released during the legendary 1999 cinematic year, forcing it to compete against a truly remarkable number of movies that were box office hits (The Phantom Menace, The Sixth Sense), attracted critical acclaim (Magnolia, Being John Malkovich), or went on to become cult classics (Fight Club, Three Kings). Among such remarkable competition – there are entire books about just how celebrated the movies of 1999 have been – it would be tough for such a quiet and contemplative film to secure a great deal of attention. I’m not surprised that its anniversary has passed largely without comment.
But I myself feel moved to mark the occasion, for a few reasons, one of which is my personal relationship with the source material. I’ve read the memoir the movie was based on at least ten times, and particular passages many more times than that. Watching a movie adapted from a beloved book can be a famously excruciating process, but in this case I’ve generally been able to view the book and the movie as two separate texts, texts which are in conversation with each other in interesting ways. I’ve been motivated to mark this occasion in part because the book is, in fact, remarkably transporting, a delicate and insightful piece of autobiography that avoids so many of the clichés that are often inescapable in the mental illness memoir space. You see, I’ve read dozens of such books, which brings us to another major reason for my interest: I have spent a little time in psychiatric hospitals myself. I don’t want to belabor that history here, but it’s worth saying that Girl, Interrupted is so valuable to me in part because it contains so little of the theatrics common to pop culture depictions of mental illness; there’s real, deep, ugly illness in the story, none of the operative, beautiful madness that’s so often depicted in movies and novels, such as in the romantic drama Mad Love or the notorious Robin Williams vehicle Patch Adams. That Kaysen’s narrative feels so lived-in and rare is what’s drawn me back to it many times, while so many other mental health memoirs seem clearly to have emphasized the more prurient details, or out-and-out stretched the truth. And to the degree that the movie is inferior to the book – and it is clearly inferior, in my opinion – it’s because, as a movie, it can’t afford to be as spare and minimalist as a written memoir.
When I read the book I’m struck by two thoughts that are in some tension with each other: I immediately understand, completely, why the book was such a hot commodity in Hollywood, coveted by many of the biggest producers in the business, and I also understand why the movie doesn’t quite work, the fundamentally unfilmable nature of that provocative text. It’s a beguiling story filled with evocative language and colorful characters, brought to life by Kaysen’s sharp pen. But almost nothing happens.
Kaysen, who had written several well-regarded if not particularly well-known novels at the time of the memoir’s release, published the book some quarter-century after the events it depicts. The product of a well-off Massachussettes family whose father worked in the heights of academia, she attempted suicide at 18, right at the end of her high school career. Or so it would appear; she had swallowed a bottle of over-the-counter pain pills, along with some hard alcohol, which would certainly suggest an effort at self-harm. But in talking to doctors, conversations much ruminated on in the book, Susanna finds herself uncertain even in her own mind whether she actually intended to end her own life. That ambiguity would color the whole experience that followed, her fundamental misgivings and confusion about the degree of her own problems core to her efforts at recovery. Which is appropriate, given the diagnosis she was given: borderline personality disorder, which has gone on to become one of the most controversial conditions in psychiatric medicine, in part because it’s traditionally been so gendered. I leave the book convinced that Kaysen was misdiagnosed, but certainly her impulsivity, lack of emotional stability, and missing sense of self fits the diagnosis, at least with the pop-culture understanding of the illness.
So diagnosed, Kaysen was shipped off to McLean Hospital, perhaps the most famous mental hospital in the country; at various times, Sylvia Plath, Ray Charles, and David Foster Wallace were patients there. And we should take care to note what that famed status meant, at least at the time of Kaysen’s stay: McLean was an expensive, tony private hospital in an era where there were still giant government asylums, before deinstitutionalization. That’s an important piece of context, because the young woman in Kaysen’s book (and it’s all young women, given that the story takes place in a woman’s ward) are all well-off, or at least their parents are. The consequences of that social class occasionally assert themselves in the memoir, though they’re generally not present in the film. Either way, Susanna arrives as an outsider, quickly comes to know and (sometimes) value the other adolescent girls in her ward, questions whether she’s really insane, and generally engages in a series of ruminations about society, identity, and mental health. She reminisces and dreams of the future. She asks herself who she is. After a year and a half, she’s released.
If it’s not immediately obvious… that’s not exactly an easy story to film! Kaysen’s control as a prose stylist is so remarkable, her ability to draw resonances and cinematic images out of the hospital so arresting, that the book practically begs to be adapted. But the story itself is remarkably devoid of meaningful events, and of course movies depict events, at least outside of the most avant garde art films. Which is why the movie, directed by James Mangold – who would go on, amusingly, to helm several movies about the superhero Wolverine – has to take so many liberties with the text. The differences between the memoir and the movie fascinate me, not just for what they tell us about books and movies but what they tell us about mental illness.
The most prominent difference is also the most expected: the book is far more dramatic and sensationalistic than the book. Absolutely no one should be surprised by that; Hollywood can’t be expected to maintain a strict attachment to mundane reality, not with a film that was at least meant to make some money. (Sadly, Girl, Interrupted eventually made its budget back in worldwide gross, but not much more, putting it in flop territory.) The question, of course, is what kind of drama would the filmmakers introduce in their retelling of the tale, what new additions they’d make to the text in order to add some narrative heft. And I’m afraid a lot of it doesn’t work.
Susanna’s most meaningful relationship in both versions is with Lisa, a deeply-damaged but glamorous fellow patient who enjoys legendary status among the other girls in the ward for her long campaign of open rebellion against the hospital’s authority. She’s sarcastic and observant and extremely assertive, qualities Susanna values. Lisa represents several things for Susanna, including a person who certainly does have a mental illness, in contrast with Susanna’s ambiguity. Lisa is genuinely unstable and diagnosed as a sociopath. And that condition, well-known for its tendency to produce a lack of guilt or respect for rules, also makes Lisa a symbol of freedom for the repressed Susanna. Where Susanna’s various rebellions in life have been quiet, inwardly-focused acts, most obviously her suicide attempt, Lisa is all externality, always ready to assert her independence – which, as you can imagine, can be difficult in a locked ward. Lisa represents a life that’s lived rather than thought, a dedication to action over analysis. This dynamic is clear in both movie and book, but as it regularly does the book punctures any sense of mystique in Lisa. While she’s sharp and alluring, with an undeniable magnetism, Lisa is also pathetic. Her skin hangs off her bones, her fingernails are yellow, she smells. She’s anorexic, after all, and anorexics are rarely very composed in terms of looks or hygiene – their obsession with being thin prompts genuinely unfortunate body transformations. Susanna jokes that she looks like she has dysentery. Lisa’s hijinks, while often funny, are also clearly the acts of a person who’s deeply unwell.
In the movie, there’s really only the glamour. Played by Angelina Jolie in what would prove to be an iconic and star-making turn, the movie’s Lisa never appears to be anything less than attractive. Jolie’s physical beauty and intense charisma leap off the screen, and the filmmakers seem to know that, playing into it by making Lisa into an almost revolutionary figure. She’s not just tough, she’s the natural defender of the other girls on a trip to get ice cream; she’s street smart and resourceful. Yes, the film makes an effort at the end to portray just how deeply damaged Lisa is, but it can’t ever quite pull off making her into a pitiable figure. The camera is a little too in love with her for that.
The most obvious change in plot terms (to the degree that the memoir has a plot) concerns Susanna and Lisa’s dramatic escape – an obvious change in that in the book, it never happens. In Mangold’s film, Lisa drags a somewhat-reluctant Susanna on an unsanctioned trip outside of the gates of the psychiatric hospital. This gives the film a chance to indulge in a little 1960s-era nostalgia, gives the two leads the chance to flirt with boys, and shows us a little more of Susanna’s lack of a sense of self; she’s unable to stand up to Lisa’s overpowering personality. The escape culminates in the film’s most famous scene, where they visit the home of a recently-released fellow patient named Daisy, played by Brittany Murphy. (The film is truly stuffed with up-and-coming young actresses.) Daisy, disturbed by the sexual predation of her father, has attempted to start a new life away from the hospital. But when penniless escapees Susanna and Lisa visit her, they find that she’s still deeply unwell. Lisa, with her usual confrontational attitude, sparks a conflict with Daisy that ends with Daisy killing herself offscreen. The shots of Ryder’s Susanna finding her body, hung from the shower with her wrists cut, are among the most indelible of the movie. After that, Susanna surrenders back to the hospital and Daisy is eventually caught.
It may not surprise you to know that in the memoir (that is, in reality), none of this happened. Daisy’s father is also portrayed as predatory and a core source of her madness in the book, she does indeed leave the hospital and does kill herself, but that all happens “offscreen,” so to speak. In the memoir Lisa has a reputation for escaping, but Susanna is defined, overall, by her willingness to go along with the hospital’s rules and procedures even when she finds them ridiculous. The book’s Susanna would never escape, not even under the influence of Lisa at her pushiest. And, of course, one photogenic young mental patient talking another photogenic young mental patient into suicide during a very cinematic argument isn’t how the world actually functions. In the memoir, Lisa kills herself off in the real world, probably for your standard issue boring mental illness reasons, and the news is relayed to the whole ward. Susanna and Lisa hear about it like everybody else and express sadness.
That change, while a big one – and, presumably, what inspired Kaysen to call the movie “melodramatic drivel” – is not one I particularly hate. Again, movies need things that happen, and there just aren’t that many in the book, which mostly alternates between Susanna’s abstract musings and remarkable character studies of the young women she shared a ward with. Daisy’s death is a big deal in the book, but had it been represented as it is in the book, as a distant event relayed through others, it simply wouldn’t have landed. Nor would it have made sense to depict her suicide without the main character present. Whether this excuses that melodrama is up to the individual. But the whole escape sequence has a great deal of propulsion, in the movie, which is telling a story that takes place amid a lot of stasis. And it helps that it allows us to see the two characters in an environment other than the hospital. For me, the escape section works.
Other changes I can take or leave. The head nurse Valerie is indeed a character in the book as in the movie, but she is not Black, which makes a lot of sense when you consider that McLean was a high-end hospital and the book takes place in the late 1960s. (That is to say, in a still highly-segregated society.) The additional element of Susanna behaving in a racist manner towards Valerie, played by Whoopi Goldberg in the movie….I suppose I’m indifferent. I admire the movie’s willingness to show its protagonist in a negative light, but this bit of racial tension, and later apology, feel like trying to stuff a little hand wringing drama into the story. It doesn’t bother me, ultimately.
I’m afraid I simply can’t defend the ending the screenwriters invented for the movie, though. It’s a mess. The conclusion is easily the weakest part of the film. And I say that with real sympathy for the filmmakers: how would one end this movie, in anything like traditional cinematic terms? In the book, Susanna ruminates as she always does, thinks about how she made it and Daisy didn’t, contemplates the nature of insanity, and leaves. We get a few reports about her future interactions with her fellow patients – including Lisa, who is revealed to have had kids and settled into upper-class parental respectability. (I’m afraid that fate would be something of a comedown to the many people who have at times idolized her portrayal in the movie.) The book ends with Kaysen going through the details of her own diagnosis, which she only obtains when composing the memoir – that is to say, more than two decades after she left McLean. You can contrast this with a scene in the film where the girls sneak into the psychiatrist’s office and read their own files, critiquing and laughing over what’s written there. The filmmakers perhaps could have made this scene the ending film in the scene, given its obvious thematic resonance and opportunity for character work. Unfortunately, they didn’t.
The ending we did get is a bizarre nightmare scenario, utterly contrived and pointless. Having gotten into a confrontation with Susanna, Lisa steals Susanna’s diary and brings it down to the tunnels under the hospital where they secretly congregate. (The tunnels are found in the book, but they are never used for anything particularly dramatic.) Lisa and the other girls from the ward stage a dramatic reading, in which they linger over all of the insulting things Susanna has said about them. Susanna finds them doing it, they all get into a big screaming match, Lisa menaces Susanna with a syringe filled with some unknown substance, Susanna manages to verbally disarm Lisa, who collapses in tears and surrender. We later see Lisa in a hospital bed, in restraints and under sedation. Susanna apologizes to her and the other girls and leaves in a cab, which is (somewhat unrealistically) being driven by the same cabbie as when she arrived. Brief dramatic monologue, and… the end.
It just doesn’t work. The ending is a bit of jerry-rigged emotionalism and conflict that doesn’t at all match the story’s basic tone of contemplation and ambivalence. All of the characters in the scene have been sketched effectively, played by strong actresses, and indeed characterization is the movie’s great strength. But the events that occur are an absurd contrivance that simply reek of screenwriters who just don’t know how to end the damn thing. I actually quite like the brief moments after that final confrontation, when Susanna is contemplating everything that’s happened, and they feature some of Ryder’s best work. But overall the ending is a bad misfire.
I suppose it’s a strange thing, to spend so much time considering the differences between a book from 1993 and a film adaptation that was released in 1999, both well-regarded by many but not often remembered today. But, as I said above, the changes fascinate me not primarily as a matter of the translation of written memoir into semi-fictional film, but as a statement about how mental illness can and can’t be portrayed in movies intended for large audiences.
In fall of 2025, Coffee House Press will publish my first novel, about a college student dealing with the onset of bipolar disorder. Many people have asked me why I didn’t tell my own story in a memoir, and indeed I’ve had people in the business prod me to write something autobiographical several times. I always tell them the same thing: there’s nothing to write! There’s no story there. My experiences with mental illness, while sometimes very serious, even life-threatening, have almost never been dramatic. There haven’t been a bunch of interesting plot points. It’s been long uninteresting months of deepening mania that leaves me pathetic and sad rather than a romantic figure, relatively brief periods in psychiatric institutions that were generally very boring, and now many many months and years of life on medication. A film where the protagonist is filmed dutifully taking his pills every day, scene after scene, might possess a certain avant garde interest. But it wouldn’t sell a lot of tickets. And this is a broader issue not just for mental illness but for a lot of social issues: that which is worth paying attention to may not be suitable for depiction in film or on TV. There’s a reason that the most famous movie about mental illness of them all, One Flew Over the Cuckoo’s Nest, is about a character who explicitly does not have a mental illness.
The film’s reception illustrated some of the dangers inherent to our constant romanticization of disorders that should not be romanticized. The film had the salutary effect of opening up a lot of conversations about mental illness, and particularly among women, who have often been written out of such discussions. There are several testimonials online that were written by women who identified with the characters in the film, sought psychiatric care, and saw their lives improve because of it. I don’t want to dismiss those things, just like I don’t want to dismiss the sheer entertainment value of the movie.
But an inherent problem with Hollywood depictions of psychiatric disorders is that Hollywood stars are beautiful and glamorous, and unsurprisingly Winona Ryder and Angelina Jolie and Brittany Murphy seem exactly that, beautiful and glamorous. The characters in the film are suffering under conditions that cause them immense psychic harm, sometimes driving them to the point of violence, self-harm, or suicide. And yet they’re also seductive, in some strange way even admirable, enviable. That sense that these young women were something to be emulated became a core part of the film’s small but diehard fanbase. At one point in time, among a certain cohort of young women, “Are you a Susanna or a Lisa?” was as meaningful a question as “Are you a Carrie or a Samantha?” I don’t want to be a grumpy old man, yelling at the youth for being young, and I understand that young people are always going to see themselves in the media they consume. But the rise of the performative school of mental illness and the online communities that enable it, just getting going on the still-young internet in 1999, has come to be one of the most consequential stories in the diagnosis, treatment, and policy regarding psychiatric illness. The way Girl, Interrupted inspired many to actively want to be mentally ill presaged troubling developments we’re dealing with here in the mid-2020s. The contemporary insistence that self-diagnosis is equally legitimate, the treatment of mental illnesses as charming identity markers, the failure to recognize that the disorders depicted in popular culture come with debilitating pathologies in real life – all of them have been exacerbated in the internet era, but also draw from a long lineage of pop culture, such as that seen in the response to this film.
Now, a quarter-century later, the most enduring legacy of the film is Jolie’s career. There’s a bittersweet element to the movie’s reception that no one could have understood at that time. Ryder, who fought for so long to get the film made, had seen the role of Susanna as an opportunity to start taking more adult roles and transition to a different part of her career. She was eager to be taken more seriously as a dramatic actress. But in fact Girl, Interrupted preceded a long fallow period for Ryder; her next major role was in 2000’s Lost Souls, a notorious bomb. (For good reason – it’s genuinely one of the most low-energy, turgid films I’ve ever seen.) While the next decade and a half saw a few choice parts, such as in Richard Linklater’s 2006 rotoscoped mind-bender A Scanner Darkly, there were no meaningful leading roles until 2016’s Netflix sci-fi series Stranger Things. Perhaps this was inevitable. Ryder was a teenage star, immortalized as a high schooler in films like Beetlejuice, Heathers, and Edward Scissorhands; those careers rarely survive the transition into adulthood. [Editor’s note: The author is neglecting 1997’s underrated pulpy gem Alien Resurrection in his appraisal of Ryder’s filmography]
But it’s impossible not to feel for Ryder, given what Girl, Interrupted meant for Angelina Jolie’s career. She had generated buzz for her role in the film Gia, but her turn as Lisa launched her into the stratosphere. She won the Oscar for Best Supporting Actress for her work in the film, along with a raft of other awards, and more importantly launched herself into several decades as one of Hollywood’s brightest lights. She took over franchises like Tomb Raider and starred in serious dramatic films like A Mighty Heart. (She was also part of a famous marriage you may have heard about.) In hindsight, the advantage for whoever would play Lisa seems obvious; it’s a role seemingly designed for a star turn. The part of Susanna, meanwhile, is rather thankless – she’s supposed to seem somewhat whiny, her illness often leaving her appearing pitiful rather than sullen and cool, like Lisa. This is, of course, what mental illness is almost always like, not stylish but pathetic, not defiant but debilitating. But movies aren’t judged for how closely they hew to reality, and that’s why we have the mental illness films we do.
We don’t need to cry any tears for Wynona Ryder, of course, as she has had a fine career overall and recently went back to number one at the box office with the Beetlejuice sequel. Susanna Kaysen never equaled the success of Girl, Interrupted again, though of course very few of us ever have either. She has always seemed to define herself primarily as a novelist, though she did publish another memoir in 2001, about her physical medical issues rather than her mental health. Her most recent book, Cambridge, was sold as a “novel-from-life,” a somewhat vague designation that likely means that she was telling her own story but was allowed to make stuff up. Her career, one way or another, has stayed concerned with her past, but with prose chops like hers, she can write about whatever she wants.
Because more people watch movies than read books, the film adaptation of her first memoir will likely endure as Kaysen’s biggest mark on culture, despite her disdain for it. I adore her memoir and do indeed find many of the film’s deviations from the real story to be wince-inducing. Yet I can’t quite join Kaysen in dismissing it. The fundamental story, the core narrative of a young woman forced to confront her fundamental ambivalence towards life in a very strange place, surrounded by other women who are just as strange as her, still resonates. The question of what exactly it means to give yourself over to psychiatric medicine still tugs at us, even those of us who do not have a mental illness. For that reason, I think the movie will endure.