Analyzing “The Bell Jar” by Sylvia Plath
August 9, 2021
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Many works of American literature pay attention to the questions of depression, suicide, search of identity, and oppression in the society. The Bell Jar, by the well-known writer and poet Sylvia Plath is one of such books. Its protagonist Esther Greenwood has several psychological and mental problems, caused by a number of social, cultural and biological reasons. This essay seeks to analyze and evaluate Esther, the main character of the novel, from a psychological point of view to determine the reasons for her crisis, identify the potential diagnosis through the process of differential diagnosis, and suggest possible ways of treatment. The understanding of The Bell Jar case can provide the reader with a broader understanding of the complexity of mental illness, diagnosis, and treatment and can serve as lesson for psychologists, sociologists, medical workers, and other related professionals.
According to the text, Esther first meets the psychiatrist Dr.Gordon while in a state of strong depression after arriving home to her mother from New York to Boston. If I were a social worker doing an initial psychosocial and diagnostic assessment of Esther Greenwood and met Esther at the same time as Dr.Gordon in a mental health clinic, I would definitely act differently than Doctor Gordon. Of course, the severe depressive state of Esther was potentially dangerous, therefore Gordon prescribed electroshock therapy to quickly improve the situation. However, according to my point of view, this step was taken too early and perhaps was not necessary at all. Prescribing electroshock therapy after only a few visits and not knowing enough about the person, her character, her life, her problems, and the reasons for her depression was unprofessional (Barkley, 2009). I would try to communicate with the girl as much as possible in order to understand the underlying reasons for her state and I would encourage her to think about her life, including the good sides and the bad sides, the victories and the defeats, the friends and enemies, the past and the future. I would try to reveal what makes her happy and what she has to do to be happy in both her personal and professional life. I would also try to understand how her childhood trauma, such as her father’s death, and how her relations with the mother. which seems to be good, but not close or warm, impact her present state. In addition, I would try to understand why the social environment and the traditional standard social roles do not fit her and to comprehend which social roles is she interested in and why. I would also try to identify whether the deep ontological insecurity and constant lack of psychological comfort is pathological or a result of a complicated period in her life, including adolescence, lack of parental connection, etc., or both. In conclusion, I would make a comprehensive biopsychosocial assessment, covering ifferent questions in the biological sphere (history of the disease addiction, utilization of different medication, family history of the disease, etc.), the sociological sphere (family, relations, home and work arrangements, etc.), and the psychological sphere (availability of psychiatric illness, recent stressors, risk of suicide, etc.).
At the same time, as a social worker, I would know that the problems of Esther Greenwood were not new at all. Nobody in the world fits into the society perfectly; everybody has personal and professional problems which they face every day. In other words, the problems matter less than how a person deals with them, both in the short-term and in the long-term perspectives (First & Tasman, 2010). All people are different. However, everybody needs assistance at some point in life. Some people find solace in friendship, love, passion, hobbies, or traveling, while others need medical intervention in the form of pills, medical procedures, conversation with doctors, etc. I would try to encourage Esther to try both ways of treatment, and I will inform her on the advantages and disadvantages of each.
Esther felt that she was unable to control her life anymore. The burden of the problems and challenges was too big, so there were only two possible solutions: to die or to ask for help, both of which were available to her. In other words, her plea for help at a medical establishment was her last hope, because nothing else worked. She thought that there was a possibility that with medical assistance her life would change for the better and she would be able to lead a life that satisfied her. The main problem that worried her was her constant state of depression and inability to fit into any social group that surrounded her.
In order to understand Esther and make a proper diagnosis, it is necessary to take into account a number of social, biological, cultural, and environmental factors. The first factor that defines the personality of Esther is her family, which is a social factor. Her father died during her childhood, leaving his daughter with the psychological trauma of loss for life. At the same time, even though her mother leaves an impression of a good woman and caring mother, it seems like Esther does not feel a close emotional connection with her. The relationship is not filled with warmth and friendship. The second factor that defines the personality of Esther is her inability to decide what she likes and what she wants, which is a biological factor. Even though she was successful at school, won competitions, studied well at the university, and had a good career starting point, she was never happy or satisfied with what she had. This factor can be explained by the biological and psychological factors that affected the formation of her personality. The third aspect that defines her personality is the post-war environment that promoted and encouraged only family-oriented women that did not want higher education or career and that did not have any ambitions in life. This lack of societal accepttance is a social factor. Such an environment was the complete opposite of what Esther dreamed of and wanted. This statement can be supported by the following citations from the book: “I never wanted to get married” (Plath 79) and “Children make me sick” (Plath 113). In other words, Esther tried to oppose the existing feminine stereotypes, but was trapped in it instead.
Additionally, the aggression turned inwards theory could be used to analyze the psychological state of Esther. According to the theory, the synergy of environmental and genetic factors impacts the mental relations and health of the person (Haddad, Neiderhiser, Spotts, Ganiban, Lichtenstein, & Reiss, 2013). In other words, Esther’s depressive state can be explained by her subjective perception of the surrounding world in combination with the inborn traits of character. According to Freud, anger turned inward develops when the aggression that person feels for others who let them down or hurt them is turned inward. Esther was in such a situation, because she could not express anger to others and because she was scared of them and in many ways dependent on them. In addition, Esther’s state can be explained by the influence of other people on her and the way she felt about it. In fact, aggression turned inward is similar to a flame – it can burn, consume, cause severe pain and depression or it can create passion, inspire, give warmth, and cast light. Unfortunately, Esther did not manage to transform her feelings into something productive.
After a careful analysis of Esther’s personality as described within the book, the following DSM – 5 diagnoses can be defined: V62.4 Z60.3 Acculturation difficulty; 308.3 F43.0 Acute stress disorder; 301.83 F60.3 Borderline personality disorder; 312.82 F91.2 Conduct disorder, Adolescent-onset type; 780.52 G47.00 Insomnia disorder; 296.34 F33.3 Major depressive disorder, Recurrent episode, With psychotic features; 301.81 F60.81 Narcissistic personality disorder; V69.9 Z72.9 Problem related to lifestyle; V60.3 Z60.2 Problem related to living alone;
295.70 F25.1 Schizoaffective disorder, Depressive type; V62.9 Z60.9 Unspecified problem related to social environment; V62.4 Z60.4 Social exclusion or rejection; V61.10 Z63.0 Relationship distress with spouse or intimate partner ; V15.49 Z91.49 Other personal history of psychological trauma (New York State Council for Community Behavioral Healthcare, 2014). The diagnosis “Other personal history of psychological trauma” can be supported by the fact that Esther’s depression begun after the death of her father. Since that time she stopped being happy about the world around. Moreover, the Boston suburb’s emptiness, as well as the bitter social portraits of her schools, served as a factor in this horrible childhood trauma.
The diagnosis “Insomnia disorder” is supported by the fact that Esther often could not sleep for a long time. This fact can be supported by the following phrases from the book: “I hadn’t slept for seven nights” (Plath 128). The diagnoses “Acculturation difficulty”, “Social exclusion or rejection”, and “Unspecified problem related to social environment” can be explained by the fact that Esther felt estranged in the American society, not being able to fit within the definition of what a traditional American should be. Moreover, the diagnosis correlates with the protagonist’s German background. She was self-conscious, because the atrocities of Nazi were still fresh in the public memory. Her growing up in a family without a father, which was non-traditional, and her modest origin compared to the others at her college further contributed to the issue. She felt estranged both on a personal and professional levels, being alone while communicating with the others in the short-term and in the long-term perspectives. All these factors influenced her complicated psychological state and multiple depression related diagnoses. The diagnosis “Relationship distress with spouse or intimate partner” can be supported by the fact that Esther could not find a fitting partner for social and sexual life. All her experiences were filled with disgust, lack of satisfaction, as well as psychological and physical pain. Therefore, Esther only regarded men from a negative perspective – as hypocrites and exploiters. The diagnoses “Problem related to lifestyle” and “Problem related to living alone” can be supported by the fact that Esther chose a lifestyle that was not appropriate for her. She did not fit the job and social environment of New York, therefore she constantly felt depressed and unhappy. However, everything could be different if Esther decided to live in a smaller city or work for another company. Additionally, due to the fact that Esther lived alone in a big city, she felt lonely and lost. The diagnosis “Narcissistic personality disorder” can be supported by the fact that the woman was constantly focused on herself and her own problems. Being so concentrated on her own personality, she forgot about the world around and people that surrounded her. It is a well-known fact that one’s vision of the world and understanding of it depends on personality. The same events, activities, and people could be seen from different angles. Being a healthy woman with a good background and education, she could have been happier, however due to such reasons as depression and narcissism Esther drowned in her own problems.
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The diagnoses “Major Depressive Disorder, recurrent episode with psychotic features”, “Conduct disorder, Adolescent-onset type” and “Acute stress disorder” are supported by the lack of interest towards anything, low self-esteem, constant thoughts and attempts of suicide, and inability to make the decisions. Moreover, the protagonist presented with the following symptoms of depression and stress: feelings of hopelessness, sadness and, emptiness, lack of psychological comfort and balance, insomnia, weight gain, irritability and anxiety (Herrman, Maj, & Sartorius, 2009). In other words, Esther felt that family, friends, colleagues, and other people around tormented her everywhere, including school, stores, and the mental hospital. The diagnosis of “Schizoaffective disorder, Depressive type” can be supported by the fact that Esther had a combination of mood disorder, depression, and schizophrenia.
The differential diagnosis “Borderline personality disorder” can be supported by the fact that the girl could not find and define her own identity. She wanted to be similar to two of her friends at the same time, who were different in terms of character, ambitions, goals in life, and appearance. In addition, Esther could not find herself in any of the traditional social roles, such as a mother, a wife, an employee, a friend, etc. (Cahyadi, 2017). Even in the mental hospital, the protagonist feels as if in the wrong place. She feels that all the places were too traditional, too rule-bound, too insensitive, and too unimaginative to feel comfortable in even a the short period of time. Only in the bell jar inside of her mind she could allow herself to be free.
Talking about the treatment approach for Esther Greenwood, it is important to state that nowadays there are a number of effective and safe methods to treat severe forms of depression, which were not available to the protagonist in the past. To start, Esther Greenwood is recommended to go to a local mental health professional and have special psychotherapy courses to talk about the mental problems and issues that worry her. During the series of individual psychotherapy meeting, the mental health professional can develop a set of special recommendations and ease depression symptoms by finding effective ways to cope with the problem. Additionally, a mental health professional can recommend medication therapy from the selective serotonin reuptake inhibitors (SSRIs). SSRIs have fewer harmful side effects as compared to other kinds of antidepressants. For example, Esther Greenwood could potentially take escitalopram (Lexapro), sertraline (Zoloft) or citalopram (Celexa). In case there are no positive results, I would prescribe serotonin-norepinephrine reuptake inhibitors (SNRIs). SNRIs (for example, duloxetine (Cymbalta) or venlafaxine (Effexor XR)) have more side effects, but they also have more advantages as compared to SSRIs (Mayo Clinic Staff, 2017). Finally, if SSRIs and SNRIs do not help, it is necessary to prescribe monoamine oxidase inhibitors (MAOIs), such as tranylcypromine (Parnate) or isocarboxazid (Marplan), combining them with a strict diet (Mayo Clinic Staff, 2017).
Furthermore, it is possible to prescribe electroconvulsive therapy (ECT) if all the methods presented above do not have a positive effect on the patient’s health. ECT is considered to be one of the most effective approaches to treating severe depression or suicidal thoughts of the patients. During an ECT procedure, the patient should be under general anesthesia and electrodes should be placed on their scalp. ECT induces finely controlled electric current into the patient’s brain, which causes a brief seizure. Thanks to the quality and effectiveness of the method, ECT is considered to be one of the quickest methods to relieve symptoms of severe depression. It is also very effective for patients who suffer from mania or a number of other mental illnesses. However, ECT has a strong disadvantage – its effects do not last for a long time. Therefore, further treatment would be obligatory (Goldberg, 2016). ECT did not help Esther, but it is possible the doctor did something wrong. Vagus nerve stimulation (VNS) was not possible during the time of Esther Greenwood’s treatment, as it is a rather new method. However, it could also be useful for dealing with her depressive state. The main idea behind VNS is that peacemaker-like device is surgically implanted, so it can it electrically stimulate the vagus nerve that runs into the brain (Goldberg, 2017). Moreover, the transcranial magnetic stimulation (TMS) that uses magnetic field created by electromagnetic coil for impacting the brain could have been applied in the case of Esther Greenwood. The main benefit of it is that it sends a much smaller electric current into a specific part of the brain without causing loss of consciousness or seizure of consciousness.
If Esther decided to consult a medical establishment earlier, when the state of her depression was not as severe, I would prescribe alternative therapies like massage, herbal remedies, relaxation, aromatherapy, biofeedback, hypnosis, yoga, chiropractic treatments, guided imagery, and acupuncture. If any of the above-mentioned methods help and if the patient agrees, I would prescribe the following experimental depression therapies: hormone replacement therapy to avoid women-related depressions (premenstrual syndrome, premenstrual dysphoric disorder, post childbirth depression, post-menopause, etc.), intravenous ketamine that provides quick recovery from depression, and Riluzole as it proved to impact the neurotransmitters positively and therefore to treat depression (Goldberg, 2017). However, it is important to remember that the effectiveness and safety of these methods are still investigated. All in all, the utilization of the above-mentioned treatments could have been helpful to Esther Greenwood.
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To conclude, it is important to state that the book The Bell Jar is not only a valuable work of American and world literatures, but also a significant source for sociological, historical, and medical research information. The readers should treat Plath’s novel as a lesson and not repeat the numerous mistakes of the past, such as restriction of women, discrimination, inequality, absence of justice, to achieve a prosperous and happy future for a healthy, well-rounded, and balanced society. All in all, The Bell Jar is a wonderful symbol not only of Esther’s madness, but also the madness of the whole era that has put women in the bell jar of inequalities and false ideals. Unfortunately, the modern treatment methods were not available in the time of Esther Greenwood, so she had to suffer because of ineffective and often unprofessional medical care. Her example should definitely be taught in medical educational establishments as a case study in order to teach future medical professionals to deal with patients with similar problems. Depression is one of the leading problems not only in the United States, but all over the world. Therefore, Esther Greenwood’s case would be relevant for many years to come. However, The Bell Jar is not only a story of depression and other mental sicknesses, but also a story of the fight, recovery, and redemption, which motivates the reader to find a relevant and positive identity and which shows how important personal and professional help is in dealing with depression and other related illnesses.