Psychiatry and Art: Rachel Getting Married and Borderline Personality Disorder
By Jeffrey on January 14th, 2010Posted In: Blog,Mental Illness and Art
According to my adult psychiatry orientation package, people with Borderline Personality Disorder (BPD) have symptoms of intense and extremely unstable affect and relationships, impulsive behaviors, and overwhelming feeling of emptiness. Some patients indulge in self harm behaviors that can be non fatal or fatal. Some make frequent para suicidal gestures as a way to attract attention. In response to perceived notions of abandonment or disappointment, borderlines engage in self destructive behaviors such as cutting, overdosing, substance abuse or burning in order to “get even” or influence another person’s actions/decisions. These patients have a reputation of being manipulative and prone to splitting hospital staff.
While watching the movie Rachel Getting Married, I had a lot of fun trying to pick up on archetypal BPD traits exhibited by the main character Kym, played by Anne Hathaway, whose performance was wonderfully spiky and witty. These are some points which I feel make Kym a classic BPD.
- Kym has a long history of self destructive behaviors via substance abuse and possible eating disorder. Percocet was mentioned in one scene as one drug of choice while the eating disorder was only briefly alluded to within dialogue. The film opens with Kym going on a weekend pass from her narcotics rehabilitation program which means the drug abuse is an ongoing issue.
- She uses the wedding rehearsal as a platform to conduct a prolonged histrionic speech consisting of inappropriate 12 step Recovery Program specific humor which is lost on the wedding party. Although Kym argued that it was her way to make amends to the family, her sister Rachel calls her on it as an attention seeking act.
- Kym immerses herself in a multitude of hyper dramatic conflict situations throughout the movie with her family.
- She verbally threatens her family with impulsive self harm behaviors via drugs (“I’m gonna use again!”)for the following reasons:
- her father’s monitoring and hyper vigilance over her behavior while at home
- perceived familial abandonment after the automobile related death of her younger brother Ethan while she was driving under the influence of drugs
- Kym impulsively drives a car off road and into a large boulder after a fight with her mother.
- Kym demonstrates behavioral components consistent with BPD:
- she refuses to take responsibility of her own actions and blames her mother for Ethan’s death because he was left in the care of a “drug addict”
- she fabricated a story consisting of sexual abuse by an uncle and having to spend late nights nurturing a 50 pound anorexic sister during group therapy. Although this false story inspired the recovery of one of her co patients, it can be seen as another gesture of inappropriate behavior during a session where truth and honesty was crucial.
I enjoyed this film immensely. It was a real, honest, and very beautiful look at difficult human situations. I think Anne Hathaway accurately captures some key aspects of what I see of my BPD patients on the hospital floor. Despite how difficult and grating Kym could be at times, Anne Hathaway also instilled a likable humanity within Kym. Watching the movie, I probably gave Kym more time than I usually give the BPDs I run across in real life. That’s because in practice, I have learned to objectively distance myself from them with flat affect and firm limits. So to be honest, sometimes I don’t allow myself to see them beyond patient status. Like Kym’s father, I’m also on guard and paranoid of the unpredictability, intentions, and behaviors. But I can also empathize with Kym’s anguished inner state. Maybe what that means is I need to start viewing this patient population as incredibly messed up but still beautifully human and maybe spend an extra few minutes hearing them out.
