To the Editor:
Max Fink1 recently reviewed the positive experiences of electroconvulsive therapy (ECT) reported by 8 personal witnesses and 4 negative and widespread “stigmatizing voices.” He is right in pointing out that we, as a profession, have failed to present the favorable experiences to offset the negative images that limit the use of ECT. Therefore, I will emphasize that one of those behind the “stigmatizing voices,” Sylvia Plath, also is a positive witness, because she has described a successful ECT series after the failed one.
Electroconvulsive therapy is the centerpiece in Plath's autobiographical novel The Bell Jar.2 Fink quotes her frightening description of the first ECT course in chapter 12 of the novel. An unknown number of ECTs was given ambulatory without narcosis and a muscle relaxant (unmodified ECT), from July 29, 1953. The stimulus dose may have been too low since she felt the stimulus and/or her bodily reaction instead of being immediately unconscious, and did not improve. Later, she was admitted to McLean Hospital, Massachusetts, where she met Dr Ruth Beuscher, with whom she made a lifelong bond.3,4 In chapter 15 of the novel, she describes the first ECT course to her doctor (“the blue flashes… the jolting… the noise”), who comments, “That was a mistake… It's not supposed to be like that… If it's done properly… it's like going to sleep.” Plath was persuaded to a second course of ECT and had 5 treatments from December 15 to Christmas 1953.5 This is described very positively in chapter 17 and 18 of the novel: “…and darkness wiped me out like chalk on a blackboard… I woke out of a deep, drenched sleep… All the heat and fear had purged itself. I felt surprisingly at peace. The bell jar hung, suspended, a few feet above my head. I was open to the circulating air.”
Plath had a long-term remission following this second course of ECT, documented in several biographies, for example, “Almost immediately after these treatments, Sylvia began to recover. During the Christmas holidays, her depression seemed to disappear”4 and “Plath recovered fully, and by early February 1954 was able to return to Smith College where she had brilliantly completed her degree, written an honors theses, and led an active social life.”3 She may herself have seen her deliverance from madness by ECT as a poetic rebirth, and wrote in her poem The Hanging Man: “By the roots of my hair some god got hold of me, I sizzled in his blue volts like a desert prophet.”5
Sylvia Plath most probably had a bipolar disorder. However, she had no serious relapse until January 1963. As in 1953, this came after a very energetic and creative period with little sleep. Dr Beuscher was not available as Sylvia lived in London. Her doctor visited her daily, administered an antidepressant, but did not succeed in finding a place for her and her 2 small children in a psychiatric department. On February 11, 1963, she committed suicide. She might have been saved by another ECT series.
Per Bergsholm, MD, PhD
Department of Psychiatry
District General Hospital of Førde
1. Fink M. Bearing witness: personal and poetic descriptions of seizure therapy. J ECT
2. Plath S. The Bell Jar
. London, United Kingdom: William Heinemann Limited 1963/Faber and Faber Limited; 1966.
3. Middlebrook D. Her husband: Hughes and Plath—A Marriage
. New York, NY: Penguin; 2003.
4. Kirk CA. Sylvia Plath: A Biography
. Westport, CT: Greenwood Press; 2004.
5. McDonald A, Walter G. Electroconvulsive therapy in biographical books and movies. In: Swartz CM, ed. Electroconvulsive and Neuromodulation Therapies
. Cambridge, United Kingdom: Cambridge University Press; 2009:180–196.