Isolation and Seclusion Theme Analysis

In the early pages of her memoir, Susanna Kaysen establishes the roles that isolation and seclusion play in the experience of living with mental illness. Dealing with mental illness, she shows, is both an emotionally and physically isolating experience. At just eighteen, Susanna is recommended for admission to the McLean hospital, where she is physically secluded—and emotionally cut off—from her friends, her family, and her boyfriend. Once inside McLean, Susanna struggles with certain aspects of life inside a mental ward that deepen the feelings of loneliness already inherent in many mental illnesses. She undergoes therapy to help her with her Borderline Personality Disorder, a “character disorder” which isolates her by virtue of its difference from the chemical and electrical brain disorders of her fellow patients. She feels further isolated by the constant surveillance and distrust that characterize the environment at McLean. As Susanna attempts to adjust to life in McLean, she begins to feel more and more isolated and removed from her old life, though she is constantly plagued by memories of freedoms she once took for granted in the outside world. “Every window on Alcatraz has a view of San Francisco,” Kaysen writes, arguing that the already-isolating experiences of illness and institutionalization were even further compounded—for her and her fellow patients alike—by the stark contrast between the seclusion they experienced and their prior freedoms.

The primary impetus for Susanna’s hospitalization is a suicide attempt which she made a few months prior to her admittance to McLean. After the failed attempt, Susanna describes a kind of lightness or “airiness” which followed her around, and noted that a bad or undesirable part of herself seemed to have been cut loose. She expressed no desire to attempt to take her own life again, but her increasingly odd behavior resulted in her being sent to a therapist who diagnosed her with borderline personality disorder and recommended she be admitted to McLean right away. Her hospitalization is a “form of preventive medicine” which, with little warning, effectively leaves Susanna isolated from the world. Though Susanna had admitted to having emotional problems and felt she perceived the world around her differently than anyone else, her feelings of isolation before her hospitalization could have been those of a normal eighteen-year-old. Once in the hospital, however, Susanna’s feelings of isolation are compounded. In part because borderline personality disorder is described as a “character disorder” marked by a “pervasive pattern of instability of self-image, interpersonal relationships, and mood,” Susanna’s diagnosis comes to feel “more ominous than other people’s.” This feeling deepens her sense of isolation by setting her further apart from others living with mental illness. Whereas her fellow patients are afflicted by sociopathy, schizophrenia, depression, and PTSD, Susanna feels that her diagnosis—which was delivered after only a twenty-minute conversation with a brand-new therapist—is a direct assault on who she is rather than an attempt to understand and remedy something that is temporarily off-balance within her mind. 

The “seclusion room” is a small room on the psychiatric ward, the size of a bathroom, with one chicken-wire-enforced window in its only door which allows other patients, orderlies, and nurses to look in and see what one is up to (though Susanna notes that one can’t “get up to much in there”). The seclusion room is not soundproof, and it is the one place where the women on Susanna’s ward are allowed to “act out” without consequence, often retreating to the seclusion room to yell at the walls and release some tension. The room can be “requested” and reserved for longer stretches of private time, but anyone who requests to book the room must make a separate request when they’re ready to leave, at which point they must undergo evaluation by a nurse. Greater freedom, Susanna observes, comes at the cost of both privacy and agency. The seclusion room is symbolic of the many layers of isolation that psych ward patients face, and it demonstrates the simultaneous and competing pull toward and the desire to push away from even further physical isolation in the face of deep mental and emotional isolation. The TV room, in contrast, is a common area which is often loud, raucous, and full of life. In moments of relative wellness—and just as often in moments of pain, despair, and suffering—the women on the ward come together in a common area to vent their frustrations to one another, feel a sense of solidarity, and even stir up trouble as a means of pushing back in a different way against the isolating nature of their illnesses.

“For many of us,” Kaysen writes, “the hospital was as much a refuge as it was a prison. Though we were cut off from the world, we were also cut off from the demands and expectations that had driven us crazy. The hospital shielded us from all sorts of things.” The fragile and damaged women who occupy the ward alongside Susanna are cut off from the outside world and denied their rights to freedom and privacy, but for many, it was the demands of the world which “drove them crazy” to begin with. Kaysen complicates her argument by admitting that there are small benefits to being sequestered in a psychiatric facility. In this way, she highlights the catch-22 of isolation and seclusion, which lend comfort in the form of peace and protection at the same time that they can make a person lonely.

Kaysen’s memoir is both a critique of the institutions that provide treatment for mental illness and an honest depiction of the messy, complicated, often unfair nature of mental illness. Isolation and seclusion are, on occasion, seen as necessary ingredients in the treatment of mental illness, but Kaysen argues that these diseases and disorders are isolating enough. Although it is only a thin line which separates the sick from the rest of the world, the barrier between the two worlds—and their mutual isolation from one another—can often appear to be insurmountable. Kaysen feels that this paper-thin barrier is an injustice, as the line between “crazy” and stable cannot be perfectly mapped. The isolating experience of being treated as “crazy” only widens the gap between illness and wellness, and as Susanna and her fellow patients watch that chasm grow, their physical and emotional isolation also grows until it becomes—for some—too large to overcome.