The Bell Jar and the DSM
Note: this contains spoilers for The Bell Jar by Sylvia Plath. It also discusses depression symptoms and suicide. Take care of yourself. If you need to speak to someone, the Suicide Prevention Lifeline is available by text, online, and voice.
I am studying Sylvia Plath with FrizzLit–a wonderful online bookclub/class where I am learning so much and making new friends. Right now we are reading The Bell Jar, Plath’s memoir-novel about her summer of depression, when she interned at Mademoiselle magazine. (I loved Mademoiselle; I read it and Seventeen in middle and high school. They both took young women seriously.) I was curious about the presentation of the main character Esther Greenwood’s presentation of depression–where did it fall in the Diagnostic and Statistical Manual of Mental Disorders? I am a former disabled therapist, but I don’t think my training at Boston University, nor my curiousity about what makes people tick, will ever leave me. I brought this up at class yesterday, and my classmates asked me to share. So here is the diagnosis of Major Depressive Disorder, with the qualifier of With Melancholic Features. Since we have read the first half of the novel, ending with Esther throwing her clothes out the window, I have added short notes from those pages under the diagnosis qualifiers.
Note: in a post-graduate course on diagnosing clients, I read the entire DSM-V cover to cover. Yes, I did. Interesting experience.
Major Depressive Disorder pp. 160: depressed mood and/pr loss of interest/pleasure, with five or more of these symptoms:
depressed mood most of the day, nearly every day (sad, empty, hopeless, tearful; irritable in adolescents) The irritability explains how negative Esther is about other people. When you add the irritability to the anhedonia (lack of pleasure), the world looks bleak and ugly, and so do other people.
markedly diminished interest or pleasure in all, or almost all, activities, most of the day, nearly every day
significant weight loss when not dieting or weight gain, or decrease or increase in appetite, nearly every day
insomnia or hypersomnia nearly every day (Esther wanting to lie about in bed, craving bed)
psychomotor agitation or retardation nearly every day (walking 43 blocks)
fatigue or loss of energy nearly every day
feelings of worthless or excessive or inappropriate guilt (which may be delusional) nearly every day (not about being depressed—her making a list of what she can’t do)
diminished ability to think or concentrate, or indecisiveness, nearly every day (Esther’s struggle talking to her boss about her future)
recurrent thoughts of death (not just fear of dying), recurrent suicical ideation, without a specific plan, or a suicide attempt, or a specific plan for committing suicide
With Melancholic Features:
One of the following is present during the most severe period of the current episode of depression:
loss of pleasure in all, or almost all, activities
lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens)
Three or more of the following:
a distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness, or by so-called empty mood (she can’t do all the things she wants to do)
depression that is regularly worse in the morning (doesn’t want to go to events)
early morning awakening (at least 2 hours before usual awakening)
marked psychomotor agitation or retardation
signification anorexia or weight loss
excessive or inappropriate guilt (wasting talent, failure to thrive)
Even highly desired events are not associated with marked brightening of mood.
I hope this has helped you guys ave a richer understanding of the book from my corner of psychology and counseling. As I say on my podcast, I’m like Harriet the Spy; I want to learn everything and write it all down. Sometimes it seems eccentric or too eager, but I just love learning, even though I am now disabled and no longer a therapist.