Turning to The Bell Jar rather than the DSM

Sylvia Plath’s novel The Bell Jar was published in 1963, just a few short, cold months before she committed suicide in her London home. The novel is a portrayal of Esther Greenwood, a nineteen-year-old woman who, while on a writing internship in New York City, comes to feel that something is wrong with her. She returns home to Boston only to be met with the news that she’s not made a competitive summer writing course that had stretched before her ‘like a bright safe, bridge over the dull gulf of the summer’. This news accelerates Esther’s descent into madness.

Just after she returns home, Esther is escorted by her mother to a psychiatrist. While sitting in the waiting room of Dr Gordon’s office, Esther states that she’s not washed her hair or her clothes in three weeks, nor has she slept for seven nights, the thought of doing either ‘seemed so silly’. Esther’s reflection on the ‘sour but friendly smell’ emanating from her white blouse and dirndl skirt catalyses a mental deviation that considers whether there will be a tomorrow worth washing for:

I saw the days of the year stretching ahead of me like a series of bright, white boxes, and separating one box from another was sleep, like a black shade. Only for me, the long perspective of shades that set off one box from the next has suddenly snapped up, and I could see day after day after day glaring ahead of me like a white, broad, infinitely desolate avenue.

Does Esther mean that she is hopeful about the days of the year as they are symbolically coded white? What does the compartmentalisation of each day to a discrete box suggest? And sleep, like a black shade; does this refer to a black lampshade, a night shade, a veil, or the shade produced by the afternoon sun or the midnight moon? And the disappearance of the shade, it suddenly being ‘snapped up’, does this mean that sleep will continue to evade her, that it’s un-claimable? ‘Day after day after day’ being likened to an ‘infinitely desolate avenue’, does this mean that the days which would constitute her future are essentially bleak, lonely – bewildering and not worth waking up for?

Perhaps it is these things. But it may well be none of them.

The language of psychiatry, of The Diagnostic and Statistical Manual of Mental Disorders (DSM), has over the past sixty years constructed what has come to be regarded as the common-sense vocabulary for describing the signs and symptoms of madness. The manual was first devised in 1952 by the American Psychiatric Association and in its fifth iteration, the DSM-V continues its tradition of creating general norms for health and wellbeing through an arbitrary set of criterions, sub criterion, numerical codes, acronyms and severity specifiers. These general norms of health succeed in pathologising behaviours that deviate from them. In other words, in defining normal, the American Psychiatric Association also constructs what we have come to regard as abnormal. The DSM-V has effectively created and sustained a reductionist, third-person, dehumanising vocabulary that reinforces the authority of the medical establishment every time it is used by doctors and patients alike. Its use is pervasive across psychiatry, psychology and allied health, assuming as much as it silences.

Let’s have a look at the diagnostic criteria for Major Depressive Disorder (MDD). The DSM-V states that for a diagnosis of MDD to be given the following conditions must be met:

Five (or more) of the following symptoms have been present during the same two-week period and represent a change from previous functioning; at least one of the symptoms is either depressed mood or loss of interest and pleasure.

But why two weeks, why not three, or four? Or one? And why five or more symptoms? What if I am experiencing two of these and am in a pretty bad way? And why must one of my symptoms be loss of pleasure or depressed mood? What if loss of pleasure and depressed mood say nothing nuanced or meaningful about my experience?

The DSM-V, through its clear delineation between criteria, also assumes that each symptom or sign can be neatly contained within its own unique unit of measurement. ‘Depressed mood most of the day, nearly every day’, can be neatly delineated from ‘markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day’, which can be separated out from ‘fatigue or loss of energy nearly every day.’ It silences nuance, shades of difference and alikeness, and assumes that subjective experience can be compartmentalised into discrete units of measurement. It says nothing about wounds.

But if it’s only being used to denote the existence of a mad something in another, why might its pervasive use be so troubling?

Because if the language that I use to inform my thoughts and my speech about madness is determined by pharmaceutical companies and the medical establishment, then I am not thinking independently. It is not common sense, it is someone else’s corrupted sense of what is. This vocabulary clouds my view of our common wounds, and obscures that we are both very vulnerable bodies. And if it ultimately succeeds to blind me from my own vulnerability, then I cannot see you as vulnerable, and if I cannot see us together as vulnerable, I might not be able to cultivate empathy for you. The DSM-V is troubling because it stifles our capacity for empathy.

If the language of psychiatry stymies our ability to imaginatively reconstruct what it is like to feel human vulnerability, another’s vulnerability, perhaps the imagination that we employ when we read fiction could be a partial antidote.

Plath does something in The Bell Jar, clearly. She does something to her readers and with language. Plath draws disparate terms into implicit and explicit comparisons and in doing so surprises the reader, contradicts their expectations, creates a kind of half-drawn map that leads to nowhere in particular. We can never be sure exactly what she means, as illustrated in the above quote. Much of what she writes resists a literal reading. But in actively reading her, one must search for connections, connotations and relations.

Perhaps it is the curiosity that Plath urges within us that is itself an expression of empathy, an exercise in ‘imaginative reconstruction’, because it manifests as a willingness to know something we don’t already, to be proven wrong, to be made aware that we are innately vulnerable, wounded, and to abandon anything concrete. To be humbled by a new ‘kind’ of knowledge about madness. In other words, Plath humanises Esther by using language that is highly particular to her experience alone. If nothing else, Plath speaks to something very precise about our common relationship with language: that it will forever be an impoverished medium for expressing the strangest and most compelling feelings we are capable of.

The imaginative reconstruction that we undergo when reading Plath and fictional accounts like hers may well have a viable and much-needed place alongside psychiatric manuals in opposing the reductionist, dehumanising effects of the scientific understanding of madness that pervades as common sense. Perhaps literature’s coexistence alongside the DSM can reduce the tendency and the need to force and constrain subjective experience into arbitrary categories, criteria and sub criteria. In this way one could be deemed eligible for professional support through the generation of a new ‘kind’ of knowledge, that regards the limitations of human language as really a very beautiful thing, that we’d be fools to corrupt.


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  1. I don’t want to be deemed eligible for anything, Jessie. Freedom is not given but taken. Positive freedom in the form of secure welfare, without the policing and gatekeeping of those, eg community service workers, informed by that piece of pure codswallop the dsm three four five or six. The only way forward in this area is to disindoctrinate ? ourselves in Hobbes, Locke’s view of the self and property and maybe follow left leaning analysis, Lacan, etc. Jacqueline Rose wrote a thick Lacanian book about Plath. i didn’t know that a restored edition of Ariel was published in2010 and LAST MONTH new letters of Plath to her psych were discovered stating Ted had bashed her and wished her dead.

  2. I’d just like to add another interpretation of Plath’s words. When I read that passage in The Bell Jar, I saw it not solely as night or sleep, but each white box marked by a shade was representative of a day on a calendar and as Esther fell into insomnia / depression each calendar marking broke apart, the lines that were once sleep seemed no longer apparent, eventually revealing – in her mind – an empty future. No day came to mark off any other, and no hope came either.

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