How does Kaysen’s understanding of the validity of her own diagnosis of bipolar personality disorder differ from that of the medical community in the 1960s? In what ways do the official processes through which she is diagnosed and treated differ from her impression about what she needs at that time to get well? Consider these points as you reflect on the text to answer the question.

• How does Kaysen’s doctor determine that she needs to be admitted to McLean Hospital when she is 18 years old?
• What role does Kaysen play in her own admission to McLean? Does she have agency in this decision?
• In what ways does the treatment Kaysen receives while at McLean fail to meet her needs? How do you know?
• What are some ideas Kaysen has about why she is misunderstood by the adult nurses and doctors in charge of her mental health care?
• Does any degree of the recovery Kaysen experiences have anything to do with the treatment she receives?

Teaching Suggestion: This discussion will allow students to focus on textual details depicting perceptions of mental health and the agency (or lack thereof) that patients like Kaysen and those she befriends at McLean Hospital have in determining their diagnoses and treatment.