Post-Pharma Pedagogies: An Intertextual Feminist Approach to Teaching Depression in The Bell Jar

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Notes

¹ The course for which I assigned The Bell Jar was titled Imagining the American Mind. The course was divided into different ways of approaching conceptions of mind, including physical estimations like craniometry and phrenology and debates over the functions and uses of memory. Plath belonged to a unit called “Able in Mind,” which also covered changing definitions of genius and popular representations of autism. Brown offers a formal “shopping” period in which students are able to attend the first couple of classes and receive a syllabus before making a final decision about their schedules. A course such as this, which announces its interest in matters of emotion and interiority, would thereby likely draw a self-selective and disproportionately representative group of students who may feel a personal connection to some of the material.

² In making reference to a life as “understood through a lens of depression,” I mean any life in which a person has claimed to suffer depression or who has been diagnosed, whether clinically or interpretatively, such as in the case of a fictional character. At the same time, I choose to suggest a process of mediation in order to demonstrate the role the category of “Depression” has in recasting diverse narratives through a single interpretative “lens.” I thus mean to invoke the critique that such a diagnosis, once given, reduces all complexity to its organization: “All disturbances of emotion, cognition, relationships, and roles” England et al. write, “are attributed to the depression and the meaning of small daily events and the flux of everyday life is drawn from one grand interpretive frame—depression” (83).

³ The other chapter I assign is “Gender, Depression, Diagnosis, and Power.” Hirshbein’s arguments in this chapter have been slightly better received by students, who are able to view statements like, “Women have the social and cultural role of expressing feelings, yet if they are too emotional or too aggressive in their expression of emotions, they are at risk to be diagnosed with a personality disorder,” within the context of psychiatric authority as hostile to particular groups of people, most evident in the efforts to have Sexual Orientation Disturbance and its precursors eliminated form earlier editions of the DSM in the 1970s and before, and in conversations surrounding the much qualified definition of gender dysphoria presently in practice. Hirshbein similarly presents femininity as pathologized. The specifics of her arguments, however, that women were overrepresented in the very making of a definition of depression do more to undermine the diagnostic category than simply suggest it is over or erroneously applied to women.

⁴ I argue that this is the case, even as the standard advice for sufferers of the condition continues to include both pharmaceutical intervention and psychotherapy.

⁵ For critical histories of medical diagnosis and mental illness see Charles Rosenberg and Joseph Dumit. Both authors discuss the tensions between legitimacy and medicine: “Without a diagnosis and other forms of acceptance into the medical system, sufferers are at risk of being denied social recognition of their very suffering and accused of simply faking it” (Dumit 578). Dumit and Rosenberg likewise consider the way other aspects of culture and bureaucracy—such as the parameters for health insurance coverage, or the role of the insanity within the establishment of legal guilt or innocence (Rosenberg, Contested Boundaries)—have shaped the ways mental illness is diagnosed and treated.

⁶ A 2017 U.S. News and World Report article pits Neuroendocrinologist Robert Sapolsky against Clinical Psychologist Michael Yapko in a debate over the word “disease” as it is used to define depression. Sapolsky forwards an opinion that is commonly recirculated in the wake of events such as the recent celebrity suicides of Kate Spade and Anthony Bourdain: “I believe that it is as much of a biological disorder as is, say, diabetes.” Yapko, by contrast, fears such emphasis devalues other important factors: “While there is no question that [depression] has a biological component to it, it is about much more than biology. The disease label doesn’t really speak to that.” The primacy of biological explanations is bound, as Alain Ehrenberg writes, to the limited access to health insurance in the United States. As such, classifications such as “disease,” “illness,” and “disorder” perform concrete material functions (xvii). But medical terms are also conscripted to engineer cultural change. Sapolsky, for example, links his own preference for the term “disease” as more in the service of reversing stigmatization than in simply being accurate. Yet the view of depression as a “Calvinist moral failing, something that someone should be able to overcome with some gumption and resolve” is historically but not inherently bound to definitions that exist beyond the life sciences.

⁷ Kimberly Emmons writes, “depression sits at the intersection of physical, cognitive, and emotional realities; it is particularly vulnerable to the means of its own articulation” (1). I believe, like Emmons, that depression is both a rhetorical disease and a physical one, but that the language available to describe one’s experience literally changes what that experience is. When I combine this view with Hirshbein’s demonstration of the ways in which the category is itself fatally flawed, I am given the space to consider that asking Plath to speak to depression is not an act of retroactive diagnosis, but that she, as well as anyone, is positioned to produce a definition of depression rather than being repackaged into a box called “depression” or for that matter any other biopsychological disorder, from her time or mine.

⁸ Plath committed suicide within a month of The Bell Jar’s publication in 1963. Her cause of death is often the one thing any of my students know about her. The reason it is such a challenge to read The Bell Jar as anything but her story is compounded by the divergent ends; on its surface it would seem that Plath wrote a book about recovery but did not herself recover. We feel invited by this fact to look upon Esther’s return to normalcy as tragedy. We search for latent signs of despair in her optimistic final chapter, we mistrust Plath’s representation, we blame the circumstances between the time period the novel covers and the time of its composition (most notably this blame has been aimed at Ted Hughes, though also the limitations for a gifted woman writer and the demands of motherhood). These are not necessarily mistakes in our reading of Plath, but they may be mistakes in our reading of mental health. England et al. epitomize the temptation: “Given the opportunities, today, for women to inhabit both domestic and professional worlds, Plath’s critics, readers, and fans are left with the question of whether she would have made the choice of death today” (87). I would not ask my students to speak so authoritatively on Plath’s condition in their reading of The Bell Jar, because Esther is not Sylvia per se, but also because this recovery-centered rhetoric clearly takes the side of social over biological components of depression, reinforcing their separation.

⁹ This approach is informed both by my own beliefs about what is useful and responsible in a class space and in accordance with the most robust complaints against the circularity of the depression diagnosis. Andrew Lakoff, cited in Emmons, “succinctly describes the equation: ‘Depression should be treatable by an antidepressant’” (14). While others are less explicit in their circular reasoning, the shortcut to defining a disorder by its treatment is a crucial part of Hirshbein’s critique.

¹⁰ I have scare quoted “both” in an attempt to more faithfully represent Wilson’s pulling together of various processes, which, as I hope to demonstrate in future pages, belies the kind of additive and binary logic that “both” implies.

¹¹ Plath’s use of the act of eating as a means to demonstrate Esther’s character serves as an interesting precursor to both Lauren Berlant’s emphasis on eating in Cruel Optimism and Cvetkovich’s interpretation of Berlant in Depression: A Public Feeling. For Berlant and Cvetkovich “eating what is bad for you” (167) is symptomatic of a culture that provides sources of instant gratification in lieu of more sustained nourishment. It is not clear that Esther means to be gratified at all. She does hunger for and even relish food; she consumes primarily out of a reluctance to refuse the intentions others have for her.

¹² Esther is quick to note that “Avocados are my favorite fruit” in the present tense (28). In context, this would seem to indicate not only that she maintained her love for them despite a night of illness, but that her love is unhindered by self-harm as self-harm is something for which she has also developed a taste.

¹³ Michelle Murphy’s work on environmental illness could serve as a useful contribution to this approach as well. While not about depression, her engagement with the diagnostic status of Multiple Chemical Sensitivity (MCS) attempts to move sufferers out from under the impossible problem of being either biologically established or else illegitimate: “I try (with a toolbox assembled largely from the pairing of Judith Butler with Gilles Deleuze and Félix Guattari) to move my discussion of the “construction” of MCS out of the domain of representation and into the domain of material practices for managing bodies in space” (92–93).

¹⁴ Many of the luminaries of feminist science and technology studies, including Banu Subramaniam and Donna Haraway, find the composite “natureculture” a vital term for thinking beyond binary constructions of science and society. Subramaniam describes how this word became necessary once it became clear to her that “scientific culture was not a ‘culture of no culture’ (Traweek 1992). Rather, categories of gender, race, class, sexuality, and nation were everywhere, constantly shaping science, its practitioners, its cultures, and scientific knowledge. Over the past decade I have worked to translate this insight and my training in women’s studies and the biological sciences into a combined practice—moving a disciplinary world of natures and cultures into an interdisciplinary one of naturecultures” (2).

¹⁵ Early in Gut Feminism, Wilson discusses Tryptophan as an example of the complexity of traffic in and out of the body. Tryptophan, she explains, is not produced by the body (it must be eaten), and it is “one of the building blocks of the neurotransmitter serotonin” (28). A diet low in tryptophan could thereby illustrate the ways in which digestive processes in the body, met with traumatic experience, could have “negative effects on individual and group well-being” (28). It is important to note that tracing this kind of exchange through dietary practice works as much to undermine any claim that something is “cultural but not also biological” as it does to promote the claim to forces beyond reductive visions of heritable hormonal deficiencies: “Our social objects and structures crystallize in systems of mutuality that include, among other things, neurons, and hormones, and genes. Likewise, our neurons and hormones and genes crystallize as biological entities in systems of mutuality that include, among other things, social objects and structures” (29).

¹⁶ As part of the practical application of these ideas, I suggest it is worth class time to reflect on the terms available here and elsewhere in descriptions of depression and discuss the assumptions, limitations, and possibilities for each. I expand further on this idea in the coming pages regarding genre.

¹⁷ The metaphor I have used in class to clarify this idea asks them to consider treating one’s back pain with Tylenol and then, for lack of a better explanation, coming to understand the source of that pain as an acetaminophen deficiency. It is, as I explain to my students, an imperfect analogy, as I do not mean to discard the potential role of serotonin or dopamine in one’s depression (although we could argue that the body’s insufficient pain management could be taken as deficiency without being the cause of the pain). If we look historically at how much was understood about depression when antidepressants began to define what depression is, however, it does well to demonstrate the shortcuts that have been taken in the delineation of a complex problem.

¹⁸ The kinds of bias Hirshbein finds include a lack of attention to the cultural factors that might see men less likely to self-report than women, the exclusion of comorbid ailments—specifically drug and alcohol abuse (means of self-medication more common among men)—in depression trials, and the perhaps unconscious move among psychiatrists to shore up their own profession by insisting too soon that causes could be ascertained by effective treatments.

¹⁹ I find it interesting that Plath situates herself within this rather prosaic narrative form, not because she does not ultimately recover herself, but because so much of her suffering is self-consciously narrated as stemming from fitting herself into stories that could not contain her. The recovery genre feels, in this case, like a toxic genre, another ingestion of an expected trope at her own expense.

²⁰ I would likewise welcome the contribution of Mad Studies into this discussion. In so much as this field, “[helps] us understand health … as a project of normativity and exclusion” (Kunzel 318), it is an important perspective to bring into conversation with Hirshbein’s evaluation of who has been pathologized by whom and why. As it regards Plath, however, I confess some hesitation with this particular interaction. Mad Studies makes no secret of being championed by those who are themselves recipients of one or another psychiatric diagnosis and who take their scholarship in madness and self-identification as “mad” as “an assertion of pride over stigma” (318). One can claim such a thing for themself; I cannot in good conscience make it on Plath’s (or for that matter, Esther’s) behalf.

²¹ Amid class discussion, I have made disclaimers that note my lack of therapeutic training and emphasize that important decisions about one’s own care should not be made solely on knowledge gained in my course. I may well continue to do so, even as I suspect that while my intention is to discourage them from any rash recalculations that could set their mental health astray, brief asides such as this one may register as a cynical release of liability more than a call to encourage responsible self-care.