Noding my homework. There was a length restriction and so I had to leave out a number of details however they are all talked about above so, that shouldn't be so much an issue. It should be noted that I wrote this paper in a sort of nursing theory based manner and knowingly omitted several glaring details about Plath and her characters. I didn't even talk about Buddy Willard. Still, here it is - feel free to offer commentary or simply ignore it at your leisure.
“I felt very still and very empty, the way the eye of a tornado must feel, moving dully along in the middle of the surrounding hullabaloo” (Plath, 1966, p. 2). Mental illness is the type of disorder that can manifest in such varied and sometimes obscure ways that it is often misunderstood by those who are not personally afflicted. A mental disorder is defined as “a psychological dysfunction within an individual associated with distress or impairment in functioning and a response that is not typical or culturally expected” (Barlow, Durand, & Stewart, 2009, p. 2). The complexity of the human mind - from chemical components to physical structure - provides for a fascinating scientific field of study as well as an opportunity to dissect the very nature of human interaction. This paper will discuss the impact of mental illness from an individual and societal point of view through a brief summary of Sylvia Plath’s novel The Bell Jar. It will also define and discuss stigma as it relates to mental illness and how this is represented and portrayed throughout the novel. Current health care practices will be examined in relation to those utilized in this story. It will close with a discussion of the influence this novel might have on societal perceptions of mental illness and a reflection on the personal insights it provides.
The Bell Jar was penned by Sylvia Plath – her only novel in a career that spanned ten years and whose other work consisted almost entirely of poetry and prose pieces (Wagner-Martin, 1988, p. 243). Sylvia Plath herself suffered from severe depression and ended her own life at the age of 30, an event that has since coloured society’s perception of her writing and lead many to believe that The Bell Jar is at least partially autobiographical (Wagner-Martin, 1988, p. 304). The Bell Jar chronicles a year in the life of a young woman suffering from a mental illness that leaves her feeling detached and despondent, as though she is simply stumbling through life with no purposeful direction.
The story begins in New York City with the main character, Esther Greenwood, a nineteen year old small town girl who has been given the unique opportunity of an internship at a fashion magazine after winning a writing contest. Despite the fact that Esther has been given a significant scholarship and has excelled throughout her school years, she seems to be drowning in the repressive cultural expectations of women in the 1950s and her own self-described “madness”. She is terribly confused about sexual relationships and obsessed with her own virginity. She often alludes to feeling as though she is ruled by the madness in her head, comparing it to being trapped inside of a bell jar. This seems an apt metaphor, as a bell jar is often used to cover, seal in, and protect delicate items or instruments: “Wherever I sat—on the deck of a ship or at a street café in Paris or Bangkok—I would be sitting under the same glass bell jar, stewing in my own sour air” (Plath, 1966, p. 178).
Upon her return from New York City, Esther is to live with her mother for the summer. This is the beginning of her spiral into an unrelenting despair. Failing to gain entrance to a writing course she had applied to prior to her trip triggers a series of particularly unpleasant experiences, thoughts, and more than one failed attempt to end her own life. Esther beings to see her life as a series of telephone poles, each one representing one year: “I counted one, two, three … nineteen telephone poles, and then the wires dangled into space, and try as I would, I couldn’t see a single pole beyond the nineteenth” (Plath, 1966, p. 118). Her family doctor refers her to her first psychiatrist, Dr. Gordon, whom she detests instantly. Dr. Gordon tries and fails to treat Esther exclusively with electroconvulsive therapy. The experience is horrifying for her and leads to the suicide attempt that nearly succeeds and her subsequent admission to a specialized psychiatric facility. Here she meets Dr. Nolan, whose treatment methods will be discussed later in this paper. Dr. Nolan is responsible for Esther’s ascension from her internal madness and eventual reintegration into society and her college life. As she is preparing for her departure from the facility, Dr. Nolan warns Esther “that a lot of people will treat her gingerly, or even avoid her, like a leper with a warning bell” (Plath, 1966, p. 226).
The societal behaviour that Dr. Nolan prepares her patient for is something that is now referred to as the stigmatization of the mentally ill. Stigma is simply defined as “the mark of a spoiled identity” (Austin & Boyd, 2010, p. 34). In broader terms and for the purpose of this paper, stigma is a singular term that embodies the numerous misconceptions that surround mental illness and negatively impact the lives of those who are afflicted. Some people are so terrified of this stigmatization that they never seek help, or face constant road blocks in the form of those who do not comprehend the gravity of the situation (Austin & Boyd, 2010, p. 34). One startling statistic indicates that “despite availability of treatment, nearly two thirds of people with a known mental disorder never seek help from a health professional” (Austin & Boyd, 2010, p. 34).
The issue might be inner turmoil - the fear that if they seek assistance with their condition they are admitting weakness and inability to cope. They might fear rejection and exclusion from communities or social groups, a very real possibility even in modern culture and with our growing knowledge of mental illness disorders (Austin & Boyd, 2010, p. 34). This “self-stigmatization” is perhaps the most troubling as it often results in a diminished sense of self and contributes negatively to the success of treatment as outlined in a 2007 study funded by the National Institute of Mental Health (Watson, Corrigan, Larson, & Sells, 2007, p. 1313). Most of these stigmas stem from preconceived attitudes and beliefs perpetuated by society as a whole.
Attitudes and Beliefs
The predominate attitudes and beliefs of society in The Bell Jar impact, often harshly, on the course of Esther’s illness. It could be argued that the most significant of these beliefs, outside of the health care settings, are those of Esther’s own mother. A person with a mental illness requires a support system. When a family member starts to believe that they are responsible, it is decidedly damaging for everyone involved and they can experience “frustration, guilt, and anger when the affected family member is immobilized and cannot function” (Austin & Boyd, 2010, p. 393). Esther’s mother goes so far as to plead with her daughter to “tell her what she had done wrong” and even felt the doctors blamed her child rearing for Esther’s problems (Plath, 1966, p. 195). This type of stigmatization could be incredibly detrimental to the psyche of someone who is already suffering with their own diminished sense of self. Esther is perfectly aware that she is not “normal” and notes frequently that she is pleased with her own ability to hide her dysfunction most of the time.
Plath’s presentation of the main character is particularly interesting. She chooses to create the impression of a fully capable and functional human being with many successes and numerous people who care deeply about her who nevertheless feels she has no control over her own life or the path that she is on. Esther is incredibly naïve about her own human condition and is very easily swayed into negative thought patterns. This illustrates a key point, and likely one that the author felt particularly important given her own situation – mental illness can affect anyone and is not necessarily a reflection of intelligence or social status. There is one other significant set of attitudes and beliefs in The Bell Jar – those of the doctors involved in Esther’s care.
Mental Health Care Practices
Plath elects to present two strikingly different sets of attitudes, beliefs, and treatment protocols that were used in the 1950s and probably still persist today. She contrasts the conceited, self-important Dr. Gordon with the gentle, kind-hearted Dr. Nolan. While both are considered professionals and have established practices, Dr. Gordon does not feel the need to communicate with Esther to establish what is truly causing her problems or to establish any kind of therapeutic relationship. He pushes forcefully into electroconvulsive therapy as the only solution to her problems with no establishment of a care plan or support system. He doesn’t explain the procedure and the experience sours Esther’s entire opinion of mental health care.
Dr. Nolan has a much more patient-centred philosophy in the development of her care plan. She builds a solid, trusting, and therapeutic relationship with Esther for months before she even suggests electroconvulsive therapy. Her emphasis is on what is best for the patient and she states clearly early on that the treatment Esther received from Dr. Gordon was not administered correctly. At one point Dr. Nolan restricts all visitors much to Esther’s relief. While restriction of visitors probably seemed like a punishment to some, it was precisely what Esther needed to escape the stigmatization and unwanted commentary from well-intentioned family and friends.
Despite the obvious improvements in Dr. Nolan’s plan, none of the treatments that were used in Esther’s care would be considered commonplace in current mental health care practice. Electroconvulsive therapy, while still used and supported by some, is becoming more of a last resort than a primary intervention. Still, some of the problems that Esther faced with her electroconvulsive therapy still persist today as evidenced by a 2009 Journal of Mental Health study on the patient’s perspective post administration. This study revealed that at least one third of the patients polled felt they had an insufficient or no explanation at all about the therapy prior to its administration (Rayner, Kershaw, Hanna, & Chaplin, 2009, p. 382). Despite advances in privacy and patient consent laws, only two years ago people with mental illness were being subjected to the same things that occurred in Esther’s story some sixty years ago.
Another treatment protocol used in Esther’s care was insulin shock therapy. This treatment involved giving patients steadily higher doses of insulin until they convulsed and became temporarily comatose. It was found that “Some actually recovered their mental health, much to the surprise of everybody, and their recovery was attributed to the convulsions” (Barlow, Durand, & Stewart, 2009, p. 13). In modern practice this therapy is considered too dangerous and would not be used, although there has been much discussion about the link between insulin abnormalities and depression, primarily in diabetic patients (Lustman, Anderson, Freedland, De Groot, Carney, & Clouse, 2000).
The second half of this novel correlates with the multidisciplinary approaches used in modern mental health care practice. It has been proven that Dr. Nolan’s combination of psychotherapy and pharmaceutical intervention is much more likely to be successful long term than a one-dimensional approach (Barlow, Durand, & Stewart, 2009, p. 31).
Personal Insights and Societal Influences
The first half of this novel provides a poignant example of the potentially devastating effects of mismanaging a patient with a mental illness. Sylvia Plath used her poetic prowess to vividly portray the absolute desperation and crippling effect that mental illness can have on a person. This seems vitally important given the on-going stigmatization of mental illness that is still prevalent in modern society. Providing insight into the perspective of the mentally ill person may be the only purposeful way to help alleviate these stigmas and misconceptions. It seems as though it might be considered required reading for anyone who is having difficulty understanding the plight of someone who is dealing with a severe episode or lifelong mental illness.
This novel has, from a personal standpoint, influenced much of my own philosophy when dealing with the mentally ill and really anyone enduring a crisis in their personal or professional life. Having read the novel several times and at different stages of my own life, it never fails to invoke powerful emotions and introspection. Regardless of the life stage, it always seems to reinforce the importance of understanding and compassion for anyone involved in a situation of this nature.
Mental illness is the type of disorder that does not discriminate based on age, race, sex, or social status. While there is sometimes an increased risk of certain types of mental illness in specific demographics, a crisis can occur at any time and to anyone. The Bell Jar presents an intimate and emotionally gripping story and highlights all of the most important aspects of mental health care. These include the need to understand and discourage stigmatization of mental illness, provide individualized and multidisciplinary therapy to those affected, and the continued education of society as a whole. Esther Greenwood provides an inspirational character, despite the heaviness of the subject matter, for anyone who is suffering or has suffered from a mental illness. This is never more notable than when Esther receives her first successful electroconvulsive therapy treatment with Dr. Nolan: “All the heat and fear had purged itself. I felt surprisingly at peace. The bell jar hung, suspended, a few feet above my head. I was open to the circulating air.” (Plath, 1966, p. 206) With support, compassion, and the appropriate interventions mental illness can be managed in the community and in health care settings to the benefit of everyone involved.
Austin, W., & Boyd, M. (2010). Psychiatric & Mental Health Nursing for Canadian Practice. Philadelphia, PA: Lippincott Williams & Wilkins.
Barlow, D. H., Durand, V. M., & Stewart, S. H. (2009). Abnormal Psychology: An Integrative Approach (2nd Canadian ed.). Toronto, ON: Nelson Education Ltd.
Lustman, P., Anderson, R., Freedland, K., De Groot, M., Carney, R., & Clouse, R. E. (2000, July). Depression and Poor Glycemic Control: A meta-analytic review of the literature. Diabetes Care, 7(23), 934-942.
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Rayner, L., Kershaw, K., Hanna, D., & Chaplin, R. (2009, October). The patient perspective of the consent process and side effects of electroconvulsive therapy. Journal of Mental Health, 5(18), pp. 379-388.
Wagner-Martin, L. (1988). Sylvia Plath, the critical heritage. New York, NY: Routledge, Chapman and Hall Inc.
Watson, A. C., Corrigan, P., Larson, J. E., & Sells, M. (2007, January 25). Self-Stigma in People With Mental Illness. Schizophrenia Bulletin, 33(6), pp. 1312-1318.-Stigma in People With Mental Illness. Schizophrenia
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