he minnesota review n.s. 55-57 (2002)Maria FarlandSylvia Plath's Anti-Psychiatry1955 marked the all-time peak of inmates in American mental institutions; by 1980 this figure had shrunk to less than one-fourth of the original total. In 1950, the average stay in a mental hospital was twenty years; by 1975, it was seven months (Gillon 97). In a brief twenty-year period, institutional psychiatry had been massively and irrevocably transformed. What were the social and intellectual origins of these transformations? What were their political and economic consequences? How did contemporary critiques of psychiatry—broadly grouped under the heading "anti-psychiatry"—contribute to these changes? This article investigates the social consequences of the anti-psychiatry movement through an examination of one of the postwar period's most well-known representations of psychiatric institutions, Sylvia Plath's The Bell Jar. I argue that Plath's 1963 novel echoes the anti-authoritarian rhetoric of the anti-psychiatry movement, while simultaneously mobilizing that rhetoric on behalf of a class-inscribed reapportioning of mental health resources. Against this backdrop, Plath's novel functions not only as an autobiographical account of a highly personal experience of psychiatric illness, but also as a trenchant social critique of psychiatric institutions. Paradoxically, by locating the novel in the context of public debates surrounding psychiatry, we can begin to see its ideological commitment to the private sphere, and, more importantly, to the privatization of these institutions. Though the anti-psychiatry movement had already begun to take shape at the time of Plath's own hospitalization in the 1950s, the movement is frequently associated with the film version of Ken Kesey's One Flew over the Cuckoo's Nest, which brought the critique of psychiatry to popular audiences in the 1970s. One of anti-psychiatry's practicing clinicians, Stanford psychologist D. L. Rosenhan, attracted the media's attention with the publication of a scholarly paper in Science called "On Being Sane in Insane Places." Rosenhan's article reported on a study in which psychologically normal investigators presented themselves at a mental hospital's admissions desk and were immediately committed to inpatient care. Though their symptoms were entirely fabricated, and they never showed any subsequent signs of illness, the hospital retained the bogus patients under observation for periods ranging from seven to fifty-two days (Issac and Armat 53-54). With the enormous publicity garnered by tactics such as Rosenhan's and the mass popularity of films like Cuckoo's Nest, the anti-psychiatry movement gained adherents on both sides of the Atlantic. The movement's nonconformist, anti-establishment message struck a chord with North American audiences, bringing unexpected celebrity to figures like clinical psychiatrist R. D. Laing. In his first visit to the U.S. in 1972, a surprised Laing was greeted by bumper stickers proclaiming "I'm mad about R. D. Laing," and by invitations for interviews with Reader's Digest, Playboy, and the Today show (Issac and Armat 29). For a 70s media already entranced with counter-cultural icons like Timothy Leary and figures like Laing, flamboyant stunts like Rosenhan's were irresistible. But the irony was that by the time of Rosenhan's experiment in 1973, the "sane people in insane places" to which his article referred had virtually disappeared. Between 1955 and 1975, unprecedented numbers of insane people had been released. By 1975, the average patient stay in an asylum was a mere 2.8% of what it had been only two decades before—a mind-boggling reduction of the kind of "involuntary incarceration" at which films like Cuckoo's Nest aimed their social critique. This almost complete abdication of long-term care for the chronically mentally ill marked a dramatic transformation in the treatment of mental illness in postwar America—a transformation that was marked by fiscal and market imperatives as well as by class divisions. Yet paradoxically, even though this widespread expulsion of the mentally ill had already become a fait accompli, the public outcry against involuntary incarceration began to gain momentum. This striking temporal gap between the dismantling of institutions in the 1950s and the indignant calls for the dismantling of those same institutions in the 1970s suggests that we must look to the 1950s and early 1960s to assess the ideological leanings of anti-psychiatry. While many of the artistic and literary endeavors that we associate with anti-psychiatry are located squarely in the 1970s, the intellectual currents that shaped the movement originated in the 1950s. Erving Goffman did his fieldwork for the monumental study Asylums at the federal psychiatric institution St. Elizabeth's Hospital in the years 1955–1956; and psychiatrist Thomas Szasz and experimental clinical practitioners like Laing conducted preliminary research in the mid-50s. 1961 was a watershed year in the mainstreaming of these anti-psychiatric intellectual currents, marked by the publication of Goffman's Asylums: Essays on the Social Situation of Mental Patients, Szasz's The Myth of Mental Illness, and Laing's best-selling The Divided Self in 1960. A series of creative endeavors followed almost immediately: Ken Kesey's 1962 One Flew Over the Cuckoo's Nest, Sam Fuller's innovative 1963 film Shock Corridor, and Plath's The Bell Jar (1963, although it was not published in a U.S. edition until 1971). These intellectual trends were quickly enshrined in public policy. The Kennedy Community Mental Health Act of 1963 sought to replace state mental hospitals with community mental health centers, resulting in an immediate expulsion of former mental health patients into shelters, hotels, and prisons. Cultural and legislative authority thus converged with almost uncanny precision, gradually funneling money away from the lower socio-economic demographic towards middle- and upper-class persons who could afford mental health therapies, which were increasingly financed on a fee-for-service basis. We conventionally associate the campaign against the incarceration of mental patients with the social protest writings of figures such as Laing, Goffman, and Michel Foucault (whose Madness and Civilization, influenced by the work of Goffman, appeared in 1965). These writers objected to what they saw as psychiatry's oppressive treatment of patients, a view epitomized in Szasz's widely-repeated slogan, "involuntary mental hospitalization is like slavery." But it is important to recall that the first steps away from existing conventions of psychiatric confinement stemmed as much from economic necessity as from idealism. The emptying of America's psychiatric institutions, as shown in debates surrounding the 1963 Mental Health Act, was the outcome of a growing sense that postwar prosperity was coming to an end. Indeed, between 1939 and 1949, per patient costs for mental health treatment had accelerated a staggering 150%, continuing their upward climb through the 1950s (Gillon 91). By 1955, when Michael Gorman's Every Other Bed announced that one-half of all hospital beds were occupied by the mentally ill, the federally-mandated Mental Health Study Act of 1955 had already started to issue recommendations urging a shift away from expensive custodial care towards a new emphasis on prevention, education, and community-based treatment. In the face of shrinking U.S. economic prospects, legislators argued, the elaborate social protections that were the legacy of the 1930s were no longer feasible. Kennedy, signing the bill into law on 31 October 1963, called for a "strengthening of non-institutional services" and a downsizing of the "massive subsidizing of existing, anachronistic state public health institutions" (Gillon 93). The goal of such measures was to reduce the "number of patients in mental institutions by fifty percent" (qtd. in Gillon 96). But more importantly, the goal was to reduce costs, as Kennedy stressed: "here more than in any other area, an ounce of prevention is worth more than a pound of cure. For prevention is . . . far more economical and far more likely to be successful" (qtd. in Issac and Armat 77). The dismantling of existing psychiatric institutions thus took place in the context of a gradual dismantling of the welfare state that made state-funded treatments and institutions seem less attractive in the postwar era than they had in the previous three decades. Ironically, then, the kind of contractual psychotherapy endorsed by anti-psychiatry polemicists like Szasz and Laing was ideally suited to the redistribution of mental health resources that was already underway in the legislative and public spheres. These dramatic realignments of health and welfare policy are indispensable background for understanding the critique of psychiatry put forth in The Bell Jar. It tells the story of a young woman who circulates in and out of mental hospitals, chronicling her mental illness and eventual hospitalization and shock treatment with almost clinical precision. Living in London, Plath set out to write the novel she referred to as a "pot-boiler" in the spring of 1962—a period that coincided precisely with the months in which attacks on psychiatry by Goffman, Szasz, and Laing took center stage in the British press. Looking to the popular mental illness novels of the 1950s for her model, Plath sought to represent, in her words, "how isolated a person feels when he is suffering a breakdown." "[I] must get out 'Snake Pit,'" Plath wrote in her journal in March of 1959, referring to the best-selling 1946 novel by Mary Jane Ward: "There is an increasing market for mental hospital stuff. I am a fool if I don't relive it, recreate it" (Stevenson 154, 45). The mass-market appeal of mental breakdown novels and memoirs was evident both in the widespread circulation of Ward's novel and in the popularity of Shirley Jackson's 1951 novel Hangsaman. In this instance, Plath demonstrated a canny nose for trends. With the subsequent vogue for mental illness memoirs such as Joanne Greenberg's 1964 I Never Promised You a Rose Garden, these books assumed the status of a sub-genre for educated, middle-class women—a genre whose enduring popularity can be seen in the recent success of memoirs and films like Girl, Interrupted. Plath's novel is unmistakably indebted both to the popular 1950s mental health narratives and memoirs she called "potboilers," and to the more highbrow anti-psychiatry protest literature that had begun to be disseminated widely by the time Plath began to draft the novel in 1962. Plath, like other critics of psychiatry, finds coercive clinical practices such as Esther Greenwood's shock treatments disturbing in their brutality and violence. Mental health memoirs sensationalize this violence, whereas anti-psychiatry protest literature deplores it. Plath's novel straddles these two rhetorical modes. Even as she seeks to capitalize on the most lurid aspects of the genre by providing readers with a blow-by-blow account of her protagonist's mental breakdown, Plath seeks to interrogate the normative dimension of mental health institutions, and the normative dynamics of more mundane institutions, such as family and marriage. While she echoes anti-psychiatry's contempt for the coercive treatment of patients, Plath is less sanguine about the consensual doctor-patient relations that were the utopian ideal of clinical anti-psychiatry. In this respect, Plath's novel simultaneously endorses, and challenges, anti-psychiatry's reformist agenda. "Some private, totalitarian state"If The Bell Jar is in many respects characteristic of the mental breakdown fictions that gained popularity in the immediate postwar period, it is equally characteristic of postwar fiction's fascination with the dynamics of conformity and rebellion. While the novel's social critique is often linked to 1970s feminism, it also has powerful affinities with the critiques of the 1950s "consensus" culture seen in the writings of the decade's sociologists and beat poets. In Plath's novel, established institutions and the conformity they enforce are embodied in the psychiatric institution and the boundaries it inscribes between normal and pathological individuals. For Plath, madness emerges as a kind of liberation from social imperatives, particularly the restrictions that society imposes on middle-class women. Yet paradoxically, while psychiatric illness is imagined as a kind of antidote to middle-class conformity, it also emerges as the marker of middle-class privilege—privilege afforded in the newfound exclusivity of selective mental hospitals such as McLean. In their newly-privatized incarnations, the novel suggests, mental hospitals served less as an indicator of an individual's sanity than of her liquidity; for patients like Esther Greenwood, wealth is a prerequisite for admission. In this context, the novel's critique of institutions aims itself against middle-class conformity, while simultaneously promoting a redistribution of wealth and resources whose direct beneficiaries were affluent, middle-class citizens of the United States. The novel's critique of the medical establishment begins with its scathing treatment of Esther's boyfriend Buddy, the aspiring doctor who wins a prize in medical school for persuading the most "relatives of dead people to have their loved ones cut up whether they needed it or not" (77). For Esther, such persuasiveness represents a form of coercive medical practice, in which doctors seek to protect the public good rather than the best interests of the individual patient. Marriage to Buddy emerges as a similar loss of agency and is viewed by Esther as a kind of involuntary mental hospitalization: I also remembered Buddy Willard saying in a sinister knowing way that after I had children I would feel differently, I wouldn't want to write poems anymore. So I began to think that maybe it was true that when you were married and had children it was like being brainwashed, and afterward you went about as numb as a slave in some private, totalitarian state. (69) The terms "slave" and "totalitarian" resonate with Szaszian anti-psychiatry, which argued that "totalitarian," or institutional, medicine, was "involuntary incarceration." Szasz was not the first to compare psychiatric institutions with other forms of involuntary confinement. In his highly publicized 1946 Life article, "Bedlam 1946," A. Q. Maisel observed that American psychiatric institutions "degenerate into little more than concentration camps on the Belsen Pattern" (102); two years later, reporting on America's mental hospitals, Albert Deutsch wrote of "scenes that rivaled the horrors of the Nazi concentration camps" (Issac and Armat 67-68). Szasz, too, deplored mental health treatments as "totalitarian," proposing what he called "contractual psychiatry," in which a freely-entered contract between the patient and the therapist would form the basis for an improved therapeutic relationship. Plath's use of the terms "slave" and "totalitarian" recalls Szasz's invocation of "totalitarian" psychiatry, just as The Bell Jar's emphasis on contractual therapeutic relations recalls Szasz's support for therapeutic approaches grounded in consent rather than in coercion. Her emphasis on contractual therapies, too, reflects anti-psychiatry's characteristic attention to the patient's agency and freedom. If psychiatric institutions divide persons into normal and pathological, the middle-class institutions of The Bell Jar designate as "insane" those women who do not fit the conventional images of womanhood—Esther, who rejects marriage and motherhood, or Joan, the lesbian physicist. Esther is torn between conventional and unconventional choices, and it is her indecision, according to the novel, that constitutes her "neurosis." "I'm never going to get married," she tells her boyfriend Buddy Willard, who responds, predictably, "You're crazy" (62). Esther tells him she is unable to decide between the city and the country, between marriage and career, between chastity and promiscuity. The novel figures this indecision in the image of a fig tree; Esther imagines her "life branching out" before her "like the green fig tree" whose branches designate mutually exclusive options: "a husband and a happy home and children"; "a famous poet"; "a brilliant professor"; and "an amazing editor" (62). "I'm neurotic," she explains to Buddy, invoking the diagnosis often counterpoised to the more intractable mental illness of the psychotic. Esther's unwillingness to marry is thus figured as a kind of mild mental illness, neurosis, and her prospective husband is deemed unsuitable insofar as he embodies the coercive practices of medical and mental health institutions. In this way, many of the novel's most emphatically feminist moments find vivid expression in its attacks on psychiatry and on medicine. Buddy's patriarchal tendencies are visible in the "totalitarian" practices of the medical profession itself, so that oppressive medical and psychiatric institutions function as a figure for sexist institutions more broadly. In The Bell Jar, as in the anti-psychiatric treatises of clinicians like Laing, madness represents one possible release from the deformations of social convention, emerging as Esther's best prospect for liberation from conformist ideals of marriage and family. The dangers of such conformity are epitomized by the figure of Buddy's mother, who advises Esther to adhere closely to middle-class norms of womanhood which decree that "a man wants a mate" and "a woman wants infinite security" (58). A man "is an arrow into the future," Mrs. Willard counsels, just as a woman should be content to occupy "the place the arrow shoots off from" (58). In her subsequent skiing trip with Buddy, Esther inverts this notion of woman as a static springing-off point, becoming a vector-like force in her own right as she plunges headlong down the slope. Impelled by a "small, answering point in [her] own body," Esther locates herself firmly along the trajectory of male-coded prerogative, "hurtl[ing] on to the still bright point at the end" of the slope (79). At the end point of her suicidal descent, Esther achieves an idyllic calm, a sense of boundless possibility predicated upon her suicidal impulse: "I grew saintly and thin and essential as the blade of a knife" (79). In her appropriation of the male-gendered vector, and the transmutation of that vector into a powerful weapon, Esther reverses the socially-coded hierarchies of male/female and active/passive, acceding to a position of masculine-coded dominance. At such moments, madness is aligned with a prospective escape from socially-prescribed norms of gender, and the novel valorizes insanity as a liberating antidote to normative middle-class institutions of marriage and family. The novel's anti-psychiatry provides a mode of resistance for its feminist protagonist, the descent into madness serving as the vehicle for women's prospective ascent out of patriarchal culture. Yet while madness serves as the engine for women's liberation, and for escape from middle-class norms of gender, it simultaneously emerges as the site upon which new middle-class privileges take shape. In its painstaking taxonomy of mental health treatments and facilities, The Bell Jar draws careful distinctions between the public city hospital and the state-of-the-art private facility where Esther begins her return to normalcy, inscribing superior value to private, over public, care. The novel's detailed attention to the class-inscribed hierarchies of mental health treatments reflects Plath's own experience. Plath herself was initially placed in Newton-Wellesley Hospital, from which she was transferred to the psychiatry wing of the (then-public) Mass General Hospital, and finally to the exclusive, private McLean Hospital. These shifts inscribed Plath within an ascending progression of class-marked institutions, as biographical accounts have made clear. McLean brought "a private room and every advantage one of the best mental hospitals in the country could confer," biographer Anne Stevenson notes (46). Plath's benefactor, the millionaire Olive Higgins Prouty, made a lavish and well-publicized contribution to Plath's McLean hospitalization, rescuing her from the horrors of the public hospital in a chauffeured car: "[Prouty's] uniformed chauffeur drove Sylvia (accompanied by her mother and brother) from Boston to McLean Hospital in Belmont—a prestigious, beautifully rural sanatorium with one of the finest psychiatric staffs in the state" (Butscher 122). The Bell Jar fictionally recapitulates this class-marked geography of mental health care, creating a detailed sociology of psychiatric treatments that reflects anti-psychiatry's bias towards privileged Americans, depicting and at times even celebrating the asymmetrical redistribution of mental health care resources that would constitute the major legacy of the anti-psychiatric movement. Such class-inscribed distinctions are most strikingly visible in the novel's representations of the dehumanizing treatment of psychiatric patients in the public, city hospital where Esther is moved after behaving badly in the first hospital (a private facility where she is given painful shock treatments by an incompetent, as well as sexist, doctor). Esther's "bad behavior" brings her to the public, city hospital, where she encounters rowdy inmates—the novel specifically mentions Italian American immigrants—and a staff of doctors who treat patients uncaringly and indiscriminately, without regard for individual identity. Esther displays visible contempt for the city hospital and its standard of treatment, addressing her undistinguished and anonymous doctors with appellations such as "Doctor SoandSo" and "Doctor Pancreas" and "Doctor Syphilis." She finds the food inedible and kicks the "Negro" who serves the patients two kinds of beans (and no meat). The inadequacy of the public hospital's cuisine is also reflected in its inadequate standard of medical care—most notably, the repetitive treatment plan, which consists of recurrent and redundant measurement of each patient's temperature. In response to the mediocrity of the treatment she receives, Esther smashes the nurse's thermometer. From this bad behavior, excruciating shock treatments and expulsion follow—the inept recourse of an impersonal institution that attends to its own bureaucratic convenience over the needs of its patients. In the logic of the novel, Esther's contempt for the city hospital is rooted in the genuine inadequacies of the treatment she finds there, and she is subsequently removed from the "cramped city hospital ward" to a "private hospital" with extensive grounds and a golf course. The novel continues to stress the superior quality of privatized psychotherapeutic care during Esther's stay at the elegant private hospital, where her patron pays for her as if she is "on scholarship." The doctors who care for Esther are like professors, offering lessons in colonial history and local-color tales of "Pilgrims and Indians" (154). Esther compares the festive atmosphere to that of a "Girl Scout Camp," marveling at the patients "playing badminton and golf," and insisting that they "musn't be really sick, at all" (154). Esther makes friends at the Belsize house, where social life and treatment are structured around a hierarchy of freedoms and privileges, moving quickly to an enjoyment of posh amenities such as "white linen tablecloths," bone china, and fine cutlery. A uniformed wait-staff and landscaped grounds give Belsize the air of an elite country club or college, as one nurse who works at both private and public hospitals observes: "Oh, it's not a nice place, like this. This is a regular country club. Over there they've got nothing" (170). Unlike the state hospital, which as the same nurse points out is drastically understaffed—"not enough employ-ees"—the private hospital allows for intimacy and individual attention between doctor and patient (171). Doctor Nolan, the glamorous Myrna-Loyish physician who oversees Esther's treatment and recovery, embodies the kind of private, contractual, and consensual therapy between equals endorsed by Szasz and other critics of psychiatry. Dr. Nolan smokes during her consultation and leaves Esther matches. She screens Esther's visitors and even shows sympathy for Esther's dislike of her mother. Dr. Nolan subsequently facilitates Esther's sexual freedom and independence, procuring a diaphragm for her and instructing her in its use. Most importantly, Esther's second electroshock therapy is "soothing," just as Dr. Nolan promises (175). By the end, Esther is on probation and even has sex, with Dr. Nolan's consent and assistance. Echoing anti-psychiatry's emphasis on the importance of individual liberty in the process of psychiatric treatment, The Bell Jar celebrates the person-to-person private psychotherapy that was becoming the new standard of mental health care. The novel affirms the value of this redistribution of mental health resources away from the impoverished and chronically ill, and towards those middle and upper-middle class persons who could afford private medical care. It is entirely logical, then, that Esther's recovery from psychiatric illness functions to shore up her privileged but fragile class position. In the highly differentiated universe of the cutting-edge psychiatric hospital, patients move up or down a graduated hierarchy of residential facilities ranked according to the individual patient's mental fitness. Esther contemplates her own uncertain status within that system: "Either I got better, or I fell down, down, like a burning, burnt out star, from Belsize, to Caplan, to Wymark, and finally, after Doctor Nolan and Mrs. Guinea had given me up, to the state place next door" (170). This fear of falling propels Esther forward along a narrative trajectory of escalating achievements and activities which mark her return to mental health. The novel charts her progress alongside that of her competitor, Joan, as Esther ascends an elaborate hierarchy of healthy behaviors, beginning with no longer wearing her pajamas during the day, ascending to normal social interactions, and culminating in her attainment of the quasi-freedom afforded by day-time privileges. Each step forward in the progression of improved mental health is rewarded with commensurate (and class-coded) privileges: "walk privileges," "shopping privileges," "town privileges." The novel carefully distinguishes between patients like Miss Norris who fail to get these privileges and those like Esther who achieve them (167). Patients' social interactions are extensively recorded, reflecting the notion that such sociality is crucial to their successful recovery. As part of his effort to substantiate the claim that social interactions and privileges would work to cure patients, Laing had drawn up elaborate charts of patient interactions he termed "sociograms." Charting Esther's social progress and interactions with meticulous detail, The Bell Jar's narration assumes a sociogrammic form, recording the salutary effects of social interactions on individual patients. In their careful recounting of the upward mobility of individual patients, these representations also adumbrate the larger dynamic of social mobility that was the less obvious outcome of such clinical techniques: the favoring of middle-class over underclass needs in the ongoing privatization of health care and other entitlements. "Voluntary Incarceration"In The Bell Jar, the critique of visible, centralized institutions such as the asylum is simultaneously bound up in the prospective dismantling of that largest of twentieth-century institutions, the welfare state. Against the impersonality and anonymity of the psychiatric institution and its coercive exercise of power, anti-psychiatry proposed contractual relations between equals, embodied in the consensual relationship between doctor and patient. In celebrating the benefits of private fee-for-service psychotherapy, Plath's novel echoes these prescriptions, and yet Plath also goes beyond anti-psychiatry's utopian belief in voluntary, contractual psychotherapy. In The Bell Jar, even the putatively "consensual" relations between mutually-respectful doctor and patient are fraught with insidious forms of normative and authoritarian power. Plath thus cautions readers against the belief—common among anti-psychiatry's proponents—that voluntary patient compliance with psychotherapeutic techniques would ensure against the repressive treatments of the past. If madness is the inevitable outcome of Esther's resistance to socially-prescribed norms, recovered sanity is an uneventful return to her former, socially-acceptable self, in the absence of any meaningful alternative. At the novel's end, Esther's cure consists in resigning herself to social prescriptions and norms rather than escaping from them. Hospital psychiatrists pronounce her "whole and well," "patched, retreaded, and approved for the road back to college" (199), assigning her to probation with full privileges. Rather than concluding her hospital stay, however, Esther elects to live in the hospital in the time remaining before the resumption of a new semester. Joan, her friend, is also allowed to leave the asylum, but elects to remain in nearby Cambridge, sharing an apartment with one of the hospital's nurses. In both instances, the psychiatric institution seems to have migrated outward into the very fabric of society, taking up residence within, rather than outside, the individual psyche. For Esther and Joan, conformity has been internalized as a self-inscribed behavioral imperative. Individuals, rather than institutions, emerge as the enforcers of conformity par excellence, and patients such as Esther and Joan continue to embrace the dictates of the institution even after they are freed from it. The most vivid instance of this disciplinary society is Esther's friend Valerie, the inmate who has been lobotomized, but loves the asylum and chooses to stay there. Showing Esther the white scars that protrude like "horns" from her forehead, Valerie brags:
Valerie's story anticipates the most tragic moment in One Flew Over the Cuckoo's Nest, when McMurphy learns that he is the only non-voluntary patient. McMurphy attacks Nurse Ratched and is then lobotomized against his will; at the same time, many of Cuckoo's voluntary patients recover their sanity and leave the institution. The horror dramatized in Cuckoo's Nest is the horror of involuntary hospitalization—the Szaszian nightmare of being committed against your will. But what is even more disturbing, in Plath's view, is the image of those who voluntarily submit themselves to hospitalization and normalization—a form of self-regulation even more insidious and invisible than the cruder exercise of authority experienced by McMurphy. By the end of Plath's novel, mental health treatment assumes a similar cast, functioning not through repression or involuntary incarceration, but through the production of self-regulating individuals. Such invisible forms of normalization are most disturbingly in evidence in the doctor-patient relationship and are at work even in the ostensibly "consensual" therapeutic relation that was endorsed by anti-psychiatry. Esther's own doctor, the stylish Dr. Nolan, is a striking reminder of the coercion that persists in the most enlightened doctor-patient relation. In response to Esther's account of the gruesome shock treatments she has received at the previous hospital, Dr. Nolan assures her that she "won't have any shock treatments" while under her care. Yet even this basic assurance of respectful treatment is eroded in Nolan's subsequent, off-hand remark: "Or if you do, I'll tell you about it beforehand" (155). Only moments later, Doctor Nolan cheerfully informs Esther that "some people even like" shock treatments. And sure enough, by the end of Esther's hospitalization, shock treatments take their place alongside other techniques, such as insulin treatment and occupational therapy, that contribute to her eventual recovery. By imagining that the asylum's modes of incarceration and imprisonment have migrated outwards into society itself, and by conceiving of its patients as gradually adapting themselves to its disciplinary practices, Plath's novel levels its most devastating critique of psychiatry's authoritarian regimes—regimes that extend beyond coercive institutionalization and into the contractual therapeutic model promoted by proponents of anti-psychiatry. In writing the novel she called a "potboiler," Plath made deliberate use of the stylistic and generic conventions of the "mental hospital stuff" of her popular 1950s predecessors, impugning the dangerous, centralized authority of institutions such as psychiatry. Echoing the attacks on psychiatry led by contemporaries such as Szasz, Goffman, and Laing, Plath sought to evoke the repressive tendencies of large centralized institutions, typified by the asylum. Plath's critique of psychiatry, like those of her counterparts, entwines a scathing indictment of psychiatry's coercive practices—such as electroshock and lobotomy—with a sophisticated sense of the normalizing tendencies that characterize even the most consensual modes of psychiatric treatment. Plath's novel, and the enormously varied artistic endeavors inspired by anti-psychiatry, would pave the way for institutional reforms—contractual therapies, outpatient care, and privatized psychotherapy—that functioned to reallocate health care resources away from the permanent underclass of chronic psychiatric cases, into the hands of curable "neurotics" such as Esther Greenwood. Yet even as it celebrates the benefits of private, contractual mental health treatment, Plath's novel remains alert to the potential dangers of such realignments. Even in a relation of supposed freedom and mutuality such as that of Esther and Dr. Nolan, Plath's novel suggests that the dynamics of coercion abide. Freed from the top-down restrictions of the asylum's authoritarian power, the individual remains subject to that authority in the form of internalized imperatives. In its attention to the complex dynamics of power and normalization that define the nexus of mental health institutions, practices, and patients, Plath's novel reaches beyond many of its counterparts in anti-psychiatric protest literature and scholarship. The Bell Jar is instructive, however, not only for what it can teach us about what Plath and her contemporaries saw as the evils of psychiatry, but also for what it reveals about the class-based assumptions of the anti-psychiatry movement itself. Plath's novel demonstrates how the disenchantment with institutions seen in the cultural and legislative trends of the 1950s and early 60s would give impetus to the dissolution of health and welfare institutions in the subsequent two decades. Ironically, many of the first steps towards the shrinking of the welfare state stemmed not from the politics of Reagan and Thatcher, but from the anti-authoritarian polemics of figures like Kesey, Kerouac, and their contemporaries. Perhaps most revealing of the ideological ramifications of anti-psychiatry is the bipartisan support for the Lauterman-Petris-Short Act of 1967. The bill, which placed strict legal limits on involuntary mental hospitalization, passed both the House and the Senate without a single dissenting vote, finding unanimous support from both civil-liberties-oriented Democrats and fiscally-conservative Republicans. When Nixon took office in 1969, he too embraced the critique of psychiatry; though Congress continued to allocate funding to the community mental health centers, Nixon impounded it. Little more than ten years later, Ronald Reagan killed off what remained of the Mental Health Act, reallocating mental health funds in block grants to states. Though progressives blamed Reagan for the exodus of patients into America's streets, Reagan had merely finished off what Kennedy and Johnson had begun. "The snake pits have been moved to the communities," wrote one critic of the dumping of mental health patients onto America's streets and cities (qted. in Issac and Armat 45). Strangely enough, this wholesale release of mental patients into the community (a problem that would be re-described in the 1980s as the problem of the "homeless") was the unwitting legacy of an odd convergence of legislative, political, and cultural forces. From Ken Kesey to Ronald Reagan, from Thomas Szasz to Richard Nixon, from John Kennedy to Sylvia Plath—all agreed that mental health care was a matter not for the state but for the individual family or individual patient. Kennedy's hope that "reliance on the cold mercy of custodian isolation" would be "supplanted by the open warmth of community concern and capability" was never realized (qted. in Issac and Armat 102). Rather, the critique of custodial confinement that began to take shape in the 1950s, and that had taken permanent hold by the 1980s, produced not the renewed public "concern and capability" that Kennedy envisioned, but a massive and irreversible trend towards privatization. Plath's The Bell Jar is just one of the numerous literary and cultural endeavors that gave impetus to this gradual ascendancy of private solutions over state-based services. Though we inevitably look to Plath's highly private act of suicide to assess the consequences of the novel's account of mental illness, we must not neglect the dramatic and far-reaching public consequences of the mental breakdown genre in American postwar culture and society. Works Cited
Maria Farland currently teaches at Fordham University and has published on Emily Dickinson and Edith Wharton, and is working on a book-length project on gender and science. |