Seeking Compassion in the Medical Establishment

Three books, spanning 70 years in American psychiatric treatment

Content warning: discussion of suicide, mental health challenges, and assault/rape

American psychiatric systems often privilege clinical authority over women’s experiences. Literature and poetry provide a powerful challenge to the sexist and authoritative culture often associated with medical care. In each of these three books I will discuss, the narrators are institutionalized following suicidal ideation or attempts. The Bell Jar (1963), Committed: On Meaning and Madwomen (2024), and Men Have Called Her Crazy (2024). These books reveal how lived experiences reproduce gendered and even violent forms of control and weaponize mental health challenges, even within seemingly “compassionate” models of care.

The Female Doctor

Calls for increasing the number of women in medicine or STEM fields often rest on the assumption that representation alone will transform culture and remediate sexism. This assumption is flawed, especially in environments where women are “rewarded” for adopting masculine traits.

In these three books, the narrators all intentionally seek female psychologists as a response to the sexism they experience. They expect compassion, understanding, and advocacy from their female physicians—only to have their expectations betrayed.

The Bell Jar

In the novel The Bell Jar, a semi-autobiographical account of Sylvia Plath’s mental health crisis from 1953-1954 (most incidents in the novel have been corroborated with Plath’s real-life in Heather Clark’s Red Comet). The character of Dr. Nolan serves as a stand-in for Ruth Beuscher a psychologist Plath met at McLean Hospital. Both Nolan and Beuscher crossed into personal boundaries. Beuscher, for instance, engaged in activities like shopping trips and exchanged personal letters with Plath, continuing to advise her long after she had moved abroad.

In real life, Plath remained deeply attached to this relationship, confiding in Dr. Beuscher up to the days before her death. Afterward, however, Beuscher revealed confidential letters and records to biographers, including Harriet Rosenstein, who later sparked controversy for holding onto the materials for years and attempting to auction them off for large sums.

Most notably, in The Bell Jar, Esther explicitly states she does not want electroconvulsive (ECT) treatment. Dr. Nolan forces the treatment on her one morning, a huge betrayal which is framed in the novel as being a catalyst in her recovery.

Indeed, Plath did undergo ECT again very reluctantly at McLean. Evidence from Plath’s life suggests it was perhaps precipitated by the mounting bills from McLean and Plath’s minimal progress in the months she had been there. After a few ECT sessions, Plath successfully begged for treatment to be ceased and rapidly ‘recovered’ enough to return to college. Whether she was masking her symptoms to escape ECT or was truly recovered is unclear. There, however, seemed strong pressure for Plath to ‘recover’ based on Plath’s financial situation. Plath’s supporter and mentor, Olive Prouty, was funding her stay at McLean since it was unaffordable to her family.

In the 1970s, Phyllis Chelser interviewed a 35-year-old female writer (“Laura”) with a graduate degree who had been institutionalized in the mid 20th century. This interview provides some insight into Plath’s experience. “Laura”, in her early 20s, after completing graduate school was unable to find a job. She had a fight with her mother over money, and her mother had her institutionalized and experienced insulin treatments and ECT as Plath did:

Laura: Fix yourself up, they told me. So every morning I got the hot sweats [insulin therapy] and every afternoon I spent in the beauty parlor with the other women. Of course you had to pay for it. You have to hide your feelings, pretend everything is wonderful, if you want to get out. -page 224

Only one person came to see me during the treatments—to give me an I.Q. test. I must have done very we'll because they transferred me to a ‘better building’ for ‘special attention’—insulin therapy on top of shock…I was in a daze most of the time (page 229).

“Laura’s” life resembled Plath’s some ways. After her release, she moved far away from her hometown, focused on teaching, then fell in love with a man she thought of as her intellectual equal. She confided in him about the torture of her psychological treatment. They married; she supported his doctoral studies and career and then found out he was having affairs. He weaponized her past diagnoses against her, slandered her as ‘crazy’, and had her put in another psychiatric hospital.

Committed

In Committed: On Meaning and Madwomen—part memoir, part scholarly examination of women’s mental illness in literature—the narrator recounts being committed to the New York Psychiatric Institute, for several years in the early 1990s after a suicide attempt in college. She examines the pressures she faced as an institutionalized patient, including the level of crisis seemingly “required” to receive care, the systems of reward and punishment governing patients’’ behavior, and the inaccurate diagnoses (such as schizophrenia) that doctors attempted to impose on her.

The narrator describes forming a close bond with a female psychologist, “Dr. B”, whom she viewed as a maternal figure within the institution. Yet this “relationship” is later fraught: after her release, when she reaches out during a mental health crisis, her disclosures of anxiety and depression are met with a dismissive response. At one point, Dr. B shockingly tells the suicidal narrator to just go get a coffee.

In a particularly painful reflection from a 2024-vantage point, Scanlon attempts to rationalize Dr. B’s dismissal, suggesting that she herself was in her twenties, with few responsibilities beyond work, while her psychologist likely had children, a family, and significant professional demands that outweighed her distress. The passage is disturbing and painfully highlights the dismissal that many young women whose mental health challenges are perceived as merely self-indulgent if they don’t have ‘real responsibilities’ (i.e. a husband and children).

Also grappling with her bisexual identity, which was dismissed by her mental health providers of course, Scanlon went on to marry a man and stopped taking her mental health medication so she could imbibe alcohol and blend in with her husband’s social family and have children. She struggled to confide her mental health issues in her husband and ‘white knuckled’ it for years during pregnancy, breastfeeding, and then divorce and then sought further psychiatric treatment in her 40s.

Men Have Called Her Crazy

Men Have Called Her Crazy recounts the narrator’s mental health struggles in 2021, when she voluntarily commits herself to an in-patient psychiatric treatment program. She had been seeing a female psychologist for years and explicitly stated upon entering the program that she did not want a male physician, expressing a clear preference for female doctors. Of course she is assigned a male doctor.

However, the narrator’s female psychologist, who had been meeting with her via Zoom at this program, abruptly “breaks up” with her during an impersonal and devastating video call while the narrator is in a psychiatric facility. Her team of doctors in the room initially support the narrator’s interpretation that the psychologist’s behavior was cruel and sudden. However, when the narrator later reviews her institutional medical records, she discovers notes that sharply contradict her recollection. The narrator recalls disturbing incidents with this psychologist in the past, that crossed professional boundaries and could be interpreted as manipulation. She recalls incidents where they acted more like friends than doctor/patient, and how she had mis-scheduled appointments.

The Institution

Seemingly, all of these psychiatric institutions offer “compassionate” mental health care: Scanlon describes apple-picking trips and shared television time; Tendler recalls snacks, crafts, and yoga; and Plath describes beautiful rooms, manicured grounds, and craft classes. While Scanlon is in a state public hospital with considerably less amenities, Tendler and Plath reside at upper-end private facilities which offered a larger variety of occupational therapy from yoga to crafting. Yet, even these are only thin veneers for the often-times uncompassionate, authoritative, mental health treatment, the isolation from the outside world, and minimal autonomy and education over one’s health care decisions.

The Bell Jar represents, of all three, the most horrific aspects of mental health treatment. The lack of autonomy over one’s care treatment, the inability to leave, to even contact the outside world are extremely limited. The treatments are brutal. Behind the scenes, insulin shock therapy, sedation, and electroconvulsive therapy (ECT) are routine practices, to which Esther and the other patients are subjected too. One has even had a lobotomy. These treatments can have severe, long term side effects including brain damage, memory loss, and bone fractures. Esther/Plath have little to no agency over her treatment. Long-term institutionalization was not uncommon, and a persistent threat if a patient did not ‘improve’. Talk therapy was not part of her treatment and she often spent long hours alone and apathetic.

Suzanne Scanlon’s experiences straddled mid-century and more modern psychiatric practices—long-term institutionalization was beginning to be phased out due to funding cuts and a shift to newer pharmaceutical drugs. By the 1990s, as she details in Committed: On Meaning and Madwomen, institutional treatment often relied heavily on medication, with little education about side effects. She describes being prescribed and required to take a range of drugs without adequate explanation of side-effects, later developing severe tooth cavities and lifelong dental problems.

Scanlon also notes that electroconvulsive therapy (ECT) remained a common procedure in the institution, though she does not report experiencing it. Talk therapy and group therapy were more widely used, though often grounded in Freudian psychoanalysis. At the same time, there were few occupational therapy options, indoor smoking was commonplace, and opportunities for exercise were minimal. Scanlon spent many long hours, completely sedentary, reading or writing. Scanlon has similar feelings, often depicting the lack of privacy, sharing bathrooms with others, the med checks, and lack of structured activities.

Tendler’s experiences, in the 2020s, is quite different. She voluntarily checks herself into a facility she had researched beforehand, giving her a sense of agency. She chooses an all-women’s program that aligns with her needs, is allowed to leave after one to two weeks, and later returns on her own terms. She also has access to a private room. Still, her stay involves numerous psychological tests and evaluations.

Nonetheless, Tendler identifies more subtle forms of medical misogyny. When reviewing her doctors’ notes, she notices a strong emphasis on her relationship with her mother as the presumed source of her mental health challenges—an interpretation she views as reductive, sexist, and incomplete regarding the information she shared with the doctors. Clinical language pathologizes her “feminine rage” and emotional responses as symptoms of disorder rather than as understandable reactions to trauma. She is also shocked to later discover that she had been diagnosed with Borderline Personality Disorder—a diagnosis that was never clearly communicated or explained during her hospitalization, only becoming apparent when she reads her records afterward.

Tendler’s account of the psychiatric institution is, by far, more pleasant than those described by Scanlon and Plath. She forms bonds with other women, and their days include binge-watching shows and participating in group activities. However, she remains aware that this environment is still structured around observation and assessment—everything is monitored, watched, and evaluated.

What does it mean to be healed?

None of the narrators are ‘healed’ or ‘cured’ in a conventional sense when they depart the institutions.

None of the narrators are really ‘healed’ upon leaving but continue to engage in independent therapy with mixed results. Scanlon and Plath depict the experience of being on ‘probation’ as they return to college life, and the surveillance.

In Committed, The Bell Jar functions almost as a sacred text for the narrator. She rereads the novel repeatedly during college, long before her eventual breakdown and institutionalization, using it as a framework to understand her own suffering. Like Tendler, the narrator later reads the sparse, clinical medical records that contrast with the intense and emotionally charged therapy sessions she recalls. During treatment, she recalls feeling pressured to disclose sexual abuse she had not experienced, further illustrating how psychiatric narratives that pathologize patients’ lives in ways that override their own accounts. She admits frustration in her inability to receive a clear diagnosis of her mental condition.

All three women are single and must re-enter the world without stable, institutionalized care systems or familial care systems. In The Bell Jar, Esther seeks to distance herself from her mother as she returns to college life, emphasizing independence but also isolation. Suzanne Scanlon, as depicted in Committed: On Meaning and Madwomen, is nearly estranged from her family during her institutionalization, further underscoring her lack of a reliable support network.

In contrast, Tendler appears to have a more intact support system in Men Have Called Her Crazy. She maintains a close relationship with her mother—who can care for her dog—and has friends she can rely on, even as she navigates separation from her husband during a global pandemic requiring social distancing. Tendler undergoes egg freezing in hopes of one day having a child.

Esther, by comparison, lacks this kind of safety net, highlighting how access to care is overly-dependent on interpersonal relationships. Esther seeks male companionship, having ended a relationship with a college sweetheart, and is raped. Plath moved to England married a poet named Ted Hughs, had two children, and after the revelations of his infidelity suffered a personal crisis compounded by financial worries, terrible weather, the failure of The Bell Jar to sell to a major American publisher, the trauma of interpersonal partner violence from Hughs, and dangerous mixes of prescribed medication. She ended her life at the age of 30.

Scanlon struggles to navigate her bisexual identity, and to find a passion. Scanlon finished college, graduate school, became a professor, married, had a child, then divorced.

A major theme of The Bell Jar is that Esther herself is not crazy so much as the world is crazy. Many of Esther’s reactions are justifiable—sexual assault, the Rosenbergs’ execution (coordained by lawyer Roy Cohen who became Donald Trump’s lawyer and mentor), intense academic pressure, a demanding boss during her internship, and the stigma around mental health create the perfect storm to struggle to survive. Indeed, Plath faced severe intersection of various stress-inducing events that precipitated a mental health crisis.

Extending this to Committed: On Meaning and Madwomen, Scanlon offers a feminist analysis of the factors shaping her crisis, including childhood trauma, the impersonal and often disorienting transition from the Midwest to New York City, and academic struggles and unsympathetic university faculty.

Tendler, experiences a global pandemic, the breakdown of her marriage to a public figure, and struggles with self-harm, and disordered eating. She also contextualizes years of trauma and assault involving men in her life as precipitating factors.

Yet despite this complexity, the prevailing expectation around her recovery is to “get back to normal”—a framing that risks minimizing the depth of her experiences and the structural conditions that contributed to her distress. Scanlon is pressured to go off her meds so she can drink wine with her husband’s family, and she fears being revealed as ‘crazy’. Tendler feels pressured to date, to work, to endure uncomfortable sex all in the name of what she should be doing.

Compassion and Therapy

Yet, Esther/Plath, Tendler, and Scanlon seek and latch onto their female psychologists and are disappointed. Many women, in order to advance within these systems, adopt the aggressive, hierarchical norms to advance. Immersion in such environments frequently reinforces existing cultural expectations rather than disrupting them. Moreover, it is unrealistic to place the burden of increased empathy or emotional labor on female physicians, many of whom are already navigating structural pressures, family pressures, and professional precarity. Meaningful change, therefore, requires not simply greater representation, but systemic reform.

Writer Erica Jong reflects on the strange experience of being married to a therapist while undergoing psychoanalysis in her semi-autobiographical 1973 novel Fear of Flying. The novel begins as twenty-eight year old “Isadora Wing’” attends a therapists’ conference with her husband in Germany—an experience that triggers a personal crisis about the emotional distance in their marriage. She captures the emotional disconnect at the heart of it with her internal monologue towards her husband:

“I wanted affection, but you sent me to an analyst” (page 175)

Chesler also interviews women who sought female mental health professionals, and usually the experience was disillusioning:

Alice: I feel she’s [psychiatrist] abandoning me to the ‘grown-up’ world of men. She’s Saying ‘You’re a heterosexual woman. Be thankful. Go and try to find that one exceptional man, that one special ‘feminine’ man. Till your private garden and look out for yourself. Don’t tempt too many demons.’ […] She’s really telling me I can’t stay in the world of women: with her, with my mother before her, with other women now. I must go out, alone, and bear a man’s child. […] She believes—she said she believes—that even if we were all raised equally, given biological differences, that there would be attraction between the sexes (p 313-314)

Many women psychiatrists who pushed back against homophobia and sexism in medical treatment and recommendations faced professional blacklisting and reprimand. The Bell Jar has recommended reading within the medical humanities, because of its powerful description of depression and the understanding-by-experience of the related psychiatric treatments. Scanlon reflects that she wishers stories like The Yellow Wallpaper were used in medical humanities courses to gain more compassion. An underlying theme in all three memoirs is a need for care and recognition. Also, women in STEM need Feminism.

Conclusion

Spanning 70 years, these works reveal that psychiatric care continues to prioritize clinical authority over women’s self-understanding, often reproducing gendered control even when delivered by female practitioners. These books also provide a powerful challenge to this culture.

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Resources

Chesler, P. (2005). Women and madness (Rev. ed.). Palgrave Macmillan.

Clark, H. (2021). Red comet: The short life and blazing art of Sylvia Plath. Vintage Books.

Tendler, A. M. (2024). Men have called her crazy: A memoir. Simon & Schuster.

Scanlon, S. (2024). Committed: On Meaning and Madwomen. Vintage Books.

Van Duyne, E. (2024). Loving Sylvia Plath: A reclamation. W. W. Norton & Company.

Plath, S. (2005). The Bell Jar. Harper Perennial Modern Classics.

Jong, Erica. Fear of Flying. Holt, Rinehart and Winston, 1973.