Mad, Bad, and Sad: A History of Women and the Mind Doctors

by Lisa Appignanesi

  On the 14th, she’s in a panic about failing academically and not living up to past prizes, while at the same time she has a ‘perverse desire to retreat into not caring’. She has visions of herself in a straitjacket, murdering her mother and killing the ‘edifice of love and respect’. All her relations with both men and women are at an impasse. She feels incapable of feeling.

  Less than a month later, having gone home to the ‘motherly breath of the suburbs’ which ‘smelt of lawn sprinklers and station-wagons and tennis rackets and dogs and babies’, Sylvia took an overdose. Deep depression had followed the tensions of New York: disappointed at failing to get into the Harvard writing course, unable to write or sleep or eat, hating the babies and suburban women who plague her, terrified by the unravelling of her mind, the constant thoughts of death, and on top of it all an unsympathetic psychiatrist and a first, deadening course of ECT, she had swallowed the pills, crawled into a dug-out space beneath the house and waited for death. She was found by her brother two days later in a semiconscious state. Her moans had alerted him. Sometime in those two days, the pills had been vomited up. For the rest of her life, there was a scar on her face where the skin had been scraped by the rubble beneath the house.

  Plath was taken to the local hospital, then to a psychiatric unit where things went from bad to worse. (She would work at this same clinic at the Massachusetts General Hospital in 1958 as a secretary while she and Hughes were in Boston. Part of her work included recording patients’ dreams.) Finally, thanks to her patron, Olive Prouty, a place was found for her at McLean’s, with its psychotherapeutic care facilities, its lawns, golf course and badminton court. Here for five months her doctor was Ruth Beuscher–Doctor Nolan in the novel–a young attending psychiatrist in 1953. Beuscher had apparently recently taken courses in psychoanalysis at the Boston Institute, but had not been accepted as a member because of a prior application by her husband. Her relations with Sylvia seemed to provide what this depressed and suicidal young woman needed and Plath kept up a relationship with her until the end.

  If Doctor Nolan’s therapeutic function in the novel is hardly elaborated, she nonetheless emerges as the good, holding mother, in stark contrast to Esther’s own. When Mrs Greenwood comes to visit Esther, she wears the ‘sorrowful face’ of sacrificial motherhood which begs her daughter to tell her what she has done wrong. ‘She said she was sure the doctors thought she had done something wrong because they asked her a lot of questions about my toilet training, and I had been perfectly trained at a very early age and given her no trouble whatsoever.’ Her mother’s refusal to see that she is implicated in Esther’s state makes Esther throw out the birthday roses she has brought her. Passionate at last, she tells Doctor Nolan what she really thinks about this all too strong and self-sacrificial figure. ‘“I hate her,” I said and waited for the blow to fall. But Doctor Nolan only smiled at me as if something had pleased her very, very much and said, “I suppose you do.”’

  The permission to hate her mother is a crucial step in Esther’s treatment.

  Equally important is ECT. At their first meeting, Nolan has Esther talk about her earlier psychiatrist. He had given Esther ECT and under his charge it had terrified her and done nothing to avert her suicidal wishes. Doctor Nolan reassures her that they won’t use ECT here. If they do, she’ll be told beforehand and it won’t be anything like what she previously experienced. ‘Why, some people even like it,’ Doctor Nolan tells her. When insulin treatment does little except fatten Esther, leaving her imagining that she looks pregnant, Doctor Nolan breaks her word. Despite this, under her tender guidance, ECT does indeed prove as beneficial as she has promised and after five sessions, Esther’s depression lifts.

  Electroconvulsive therapy had first been developed in Rome in 1938 by Ugo Cerletti. He had seen pigs in a slaughterhouse becoming more manageable and less agitated when an electric prod was administered. Since the idea, later disproved, was around that epileptics didn’t develop ‘schizophrenia’, it was thought that if epileptic-like convulsions could be administered in patients, this would stop or ameliorate other forms of mental illness. The thinking behind shock treatment of any kind has always been and is still disputed, but some, amongst them the established figures in psychiatry, claim that producing a fit and then unconsciousness in the patient has a beneficial effect in some cases.

  ECT was welcomed by asylum psychiatrists in Britain as an advance on Cardiozol, an unreliable camphor-based convulsive, and on insulin therapy, which took an unpredictable period to build up the desired reaction of a convulsion or coma/sleep. In America, ECT first met with a certain resistance. Important asylum doctors like Harry Stack Sullivan refused to use it. The general favouring of psychodynamic rather than physical treatments in the postwar period meant it had far less popularity than in Britain, where it quickly became a staple therapy for major depression and schizophrenia. Many patients loathed and feared the passivity, the scrambling of memory, the zombie-like condition of those who came back from treatment. Others found it beneficial, calming agitation and lessening anxiety, particularly after it began to be administered with a general anaesthetic–the way McLean’s used it, an innovation at the time.

  The final step in Doctor Nolan’s treatment is that she allows Esther to go to a doctor to be fitted for a diaphragm. Sanctioned both to distance herself from her mother and to make the long-awaited entry to full womanhood, Esther returns to university, her spiralling depression left behind. Instead, her friend and double at the hospital commits the suicide that Sylvia would only implement after The Bell Jar was published.

  The Bell Jar is emphatically a woman’s book. The men in it, though desired in fantasy, are in fact distant–either dead, like the father whose grave Esther visits just before her suicide attempt, or like Esther’s boyfriend tucked away in a TB sanatorium while she nurtures her wish to rid herself of him. The mathematician who deflowers her at the end is a prop to a shedding of her virginity. She never wants to see him again. Their final transaction is a financial one in which she asks him to pay the hospital bill she incurred after sex brought on haemorrhaging. Nor is Esther friendly or kind to the women in the book who represent the dead ends of possibility. But a few of the women penetrate the bell jar of depression, and when she is at last ‘patched, retread, and approved for the road’, in a ritual which is more like being born again than married, it is Doctor Nolan–the woman who told her that what other women see in each other is tenderness–who carries her across the threshold into her new life.

  The Doctor Nolan who sees Esther into her new woman’s life will, as Ruth Beuscher, stay with Sylvia as either therapist or adviser for the rest of her days. The often irreconcilable demands of writing and being wife and eventually mother with the perfectionist zeal and passion Plath demanded of herself, together with the underlying tug of depression, led her to rely on the help of psychiatrists throughout her life.

  At Cambridge in the spring of 1956, some two weeks after she had first met Ted Hughes and bitten him on the cheek with lustful, drunken frenzy as they danced, Sylvia went to see the university psychiatrist Dr Davy whom she liked–‘calm and considered, with that pleasant feeling of age in a reservoir; felt Father: why not’. But it is Beuscher she calls on dramatically in her journal. Running through names, it is hers she focuses on. She asks Ruth to take her into her heart, to let her cry and cry and to help her be strong. Beuscher increasingly takes on the mothering of the Sylvia who needs help. She is the ‘psychologist-priestess’, her voice internalized as the ‘permissive mother figure’. Meanwhile, to her real mother Sylvia writes regular letters of astonishing calm and enthusiasm, always presenting the successful façade Mrs Plath wanted of her.

  Sylvia Plath and Ted Hughes were married on 11 June 1956. In the autumn of 1958, during the couple’s second year in Boston, while Hughes’s poetry met with increasing success, Sylvia struggled with writing, sexual jealousy and writer’s envy. Depression, a sense of her own worthlessness and the impossibility
of the battle with language and form, gripped. She turned at first secretly, and then openly, to Ruth Beuscher for psychotherapy. On 12 December that year, a fresh section of her journal records her ‘interview notes’. They show Sylvia in combative mood, pledging herself to use her sessions with Beuscher to the full. If she is going to pay hard-earned money for her therapist’s time and brain, then she will treat therapy as she would a tutorial about the emotional life. She will work ‘like hell’, probe what she calls in this intimate record of her psychoanalysis, the ‘sludge & crap’ of her inner life, to make the most out of it.

  This analytic work is not mainly to do with her tendency to turn her men into all-powerful fathers, the boot-wearing Fascist of her Daddy poem. It is to do with her mother. Beuscher has given her permission to hate her self-sacrificing vampire mother, and that, in a process more efficacious than shock treatment, makes a ‘new person’ of her.

  Sylvia fills in the detail here of that therapeutically sanctioned hatred. As she understands it through her analysis, Mrs Plath married an old man, sick as soon as she got him and ‘heiling Hitler’ in the privacy of his home. The children came as her salvation: she worked and aspired for them, gave them the best. After she had metaphorically ‘killed’ off the father, she sacrificed herself by becoming man, mother and woman in ‘one sweet ulcerous ball’, to make everything perfect for her perfect children. Sylvia disgraced her by breaking down. ‘I hate her because he wasn’t loved by her,’ Sylvia notes. The consequence is she hates men because they don’t stay around to love her like a father, because they don’t suffer like women do. The vision of love this hateful mother gave her is also hateful–security, house, money, babies, and a loved vision of Sylvia, which isn’t really her. Analysing her past actions, Sylvia sees that she displaced a deep desire to kill off her mother’s idea of her, as well as her hated mother, by attempting to murder herself instead.

  But that’s in the past. Sylvia is now–with the help of Beuscher–her own woman, strong enough to protect Ted from her mother’s murderous tendencies towards men.

  So this quintessential vampire of an American Mom can be neutralized with the help of a better mother, one with whom Sylvia can cry and think; one through whom she reads Freud’s Mourning and Melancholia and recognizes her depression as his ‘draining of the ego’, a transferred murderous impulse from her mother to herself, a self-abasement which is a transferred hate and which keeps her from writing. With Beuscher she also sees that what stops her from writing or having babies is spite, since she will have to give her mother the writing and the babies and her mother will appropriate them. She hates this witch-mother because Sylvia’s not writing proves Mrs P. correct about the need for Sylvia to do something that brings security–like teaching, which in turn makes her like her mother.

  Plath’s notes sound the clarion call for the coming generation of rebelling women–but the answer she provides is not the political one. What to do with your hate for your mother and all mother figures? she asks. What is the woman to do when she feels guilty for not behaving in the manner prescribed by the mother who has after all gone out of her way to help her? Where is one to look for an alternative figure who has the wisdom to tell you what you need to know about babies and the facts of life. The only person Sylvia trusts to fulfil this function is Beuscher, who won’t tell her what to do, but will help her find out what is in herself and what she ‘can best do with it’.

  Beuscher did help Plath through this cycle of depression. She began to go to Robert Lowell’s writing class, make new friends, amongst them the poet Anne Sexton, whose own trajectory involved a mentoring analyst. She wrote, despite the rejections. None of it was easy, but the poems of The Colossus emerged–a creative surge Plath linked with ‘the buried male muse and godcreator’. And Frieda Hughes, despite Plath’s worries about being barren, was conceived. To be deprived of having a baby, Plath writes, is death indeed: ‘to consummate love by bearing the child of the loved one is far profounder than any orgasm or intellectual rapport’.

  Plath’s notes from her sessions with Beuscher also include pointed queries from her analyst about the suitability of Ted Hughes as a husband for her. ‘Would you have the guts to admit you’d made a wrong choice?’ Sylvia says she would, but she is sanguine about the question since her husband supports her in soul and body and she loves his ‘being-there’. Does Ted want her to get better, Beuscher asks again in a later note, and again Sylvia offers an emphatic yes. The queries don’t upset her or make her link Beuscher up with the ‘bad’ mother, who had equal criticisms of Ted. Yet, in the light of Beuscher’s last intervention in Plath’s life, in that final terrible year before her suicide, what may be signs of an early mistrust of Hughes take on a slightly ominous note. Beuscher was one of the women who later urged Plath to divorce Hughes and seek a legal settlement.

  We have no way of definitively knowing whether Beuscher’s advice was one more element in the gathering storm of circumstances that led Sylvia in her last depression to take her life. On top of her jealousy and the prolonged split with Ted, which finally seemed to have come to a head in October 1962, there was that winter’s unusual and persistent cold, the children’s flu, her finances, and what she took to be the cool reception for her pseudonymous The Bell Jar. As her biographer Diane Middlebrook notes, that book itself might now have also held up too terrible a mirror to her current depressed state. To Beuscher Plath wrote, ‘I can feel my mind disintegrating again.’

  In anguish, she asked her therapist whether she could come to London. Beuscher couldn’t, and in her last weeks Plath went to the enlightened general practitioner John Horder, who provided a live-in nurse while the children’s flu took its course, then wanted to arrange hospitalization for Sylvia, so severe did he judge her condition. Space wasn’t instantly available, and on 4 February he prescribed the antidepressant, Parnate. This was meant to work more quickly than others then on the market. He saw her daily. But six days later, on the evening of Sunday 10 February, 1963, Plath carefully prepared her children’s breakfast, set the trays beside their beds, opened their windows and sealed their door. Then she went downstairs to place her head deep within the gas oven. She was thirty years old; her son Nicholas had had his first birthday a month before, and Frieda was not quite three.

  Hughes and her mother both thought that the act had been provoked at the last by the antidepressant medication: the tranylcypromine was used as an alternative to ECT and it seemed that Plath’s American doctors had established that she was ‘allergic’ to it. Hughes believed it induced the very suicidal thoughts it was intended to prevent. He had held out hope, after their meeting just a week before her death, that they might come together again, but time had run out on them.

  Aurelia Plath was ill and didn’t come to the funeral: she learned only later that Sylvia had taken her own life and determined that she must have been in a state of ‘chemical’ confusion. Ever anxious to put the best face on things, she prevented publication of The Bell Jar in the USA for eight years. When it came out in 1971 at the height of the women’s movement, she countered its portrait of her mothering by having Sylvia’s upbeat and loving letters to her published as well. Together with the intensity of Plath’s poetry, fiction and journals, they provide a record of a life which made up for its tragic brevity by its depth.

  In an interview she gave to the New York Times on 9 October 1979, when the letters were being staged, Aurelia Plath intimated that it was the psychiatrists who had turned her daughter against her:

  ‘My mother was always my best friend and I’d hoped that my daughter would be too,’ Mrs. Plath said. ‘She became ashamed of our friendship during her breakdown. I don’t want to accuse anybody. I don’t want to blame anybody, but…I came one Saturday, and then Sylvia held me off with her two arms straight out and she said, “I don’t hate you.” You see, somebody had to be the scapegoat. She couldn’t understand why she had had the breakdown. I think psychiatry has moved a long way since the 50’s. They don’t
shut out the family. The doctors and the family work together. When Sylvia was sick, only one visit a week was allowed.’

  Had Ruth Beuscher, the other mother in Sylvia’s life, allowed her one-time patient to become too dependent on her? Apparently in the 1960s, when she was Clinical Assistant Professor of Psychiatry at Harvard, Beuscher had blamed the rash of suicides at McLean’s on psychoanalytic treatment. There is no way of knowing whether this assessment was linked to the tragic culmination of her own therapeutic interventions with Sylvia Plath. Whatever the case, Beuscher began to move in a new direction, which was also an old one. She took a Master’s degree in theology, focusing on spiritual aims, and received it in 1974. Her father had been a well known Presbyterian clergyman. Six years later she was ordained, and towards the end of her career taught at a theological seminary in Texas. Psychiatrists, she thought, were often insufficiently aware of when they needed to call in a member of the clergy.

  By then traditional American psychoanalytic psychiatry was being re-examined from all directions. Ruth Beuscher was hardly alone in moving towards religion. In 1973 Hollywood, the weathervane of American culture, had already evoked one extremity of that particular route. In the landmark film The Exorcist, the hero is both psychologist and priest: only when he gives up his secular role can he save the possessed twelve-year-old heroine from demonic clutches. Marilyn Monroe’s Hollywood analyst, Ralph Greenson, stepped into the critical frame to attack the film as dangerous and for the way it degraded the medical profession and psychiatry. His intervention was already beginning to look like a retrograde action. A decade earlier and while she was under his care, Marilyn Monroe had committed suicide just six months before Sylvia Plath. It was becoming clear to America that psychoanalysts were neither foolproof surrogate parents, seers, nor spiritual guides.