Rhyme, reason and depression
Thirty years after the American poetSylvia Plath killed herself in London, the literary row over why she died is still going on. While some feminists claim that Plath was the victim of an insensitive husband, she is also accused of trying to manipulate the world around her once too often. But the doctor who cared for her in the last weeks of her life claims that the debate overlooks the real villian, and the subject of most of her poems and diary - the depression that dogged her life.
Plath's death on February 11, 1963, less than five months after she had separated from Ted Hughes, the present poet laureate, made no more than a couple of paragraphs in the local paper and a few obituaries in the literary press. Soon, however, her death was attracting almost the same kind of ghoulish coverage as that of Marilyn Monroe, who died the previous year. After the posthumous publication of a collection of later poems in 1966, the international press discovered that the beautiful young American had written haunting works of genius about death and disillusionment before putting her head in the gas oven. Both Time and Life magazines reviewed the slim volume, describing the 'strange and terrible' poems with a style 'as brutal as a truncheon' written during her 'last sick slide towards suicide'.
Plath's became a symbol of blighted female genius for the early feminist movement. She had chiselled out a literary career while doing her duty as wife and mother, and been rewarded by being abandoned with two children, no money and no proper home. American radical feminists openly accused Hughes of murder. In a 'holy war' In the seventies and early eighties, they harassed him during poetry readings, threatening to kill him. Plath's gravestone in Yorkshire was repeatedly defaced.
A different explanation came from the poet Al Alvarez in The Savage God, his 1971 book on suicide. He claimed that Hughes's view was that Plath had gambled with her death and that her suicide was an unanswered cry for help. Meanwhile, sympathisers of Hughes were claiming that she was a self-dramatising neurotic who had driven away a loving husband and then tried to force him back with a blackmailing suicide attempt. In a memoir in 1989, a neighbour recalled a woman with a 'morbidly prickly ego' who 'manipulated with the deep instinctive cunning of someone driven to get her way.'
Three months before her death, Plath had moved with her two small children into a flat near Dr John Horder, a GP in Primrose Hill, North London. Now in his seventies, Horder is a former president of the Royal College of General Practitioners. A musician and painter himself, he was close to Plath just before her death. At a time when doctors labelled depression as neurosis, hypochondriasis and hysteria, he knew from experience the sheer physical pain of a severe depressive episode, made worse by shame and the conviction that life cannot improve.
Horder was also already aware that severe depression is triggered by much the same kind of stressful events and/or relationships that bring about normal depression. It is the over-reaction that marks out the illness. During her last depression, Plath had many reasons for feeling down. She had a virus infection and was looking after two young children on her own in a new flat during a particularly cold winter, while her husband had made another relationship. Yet all this was not in itself sufficient to push her to suicidal depression, Horder believes.
Every now and then, 'the neutral and impersonal forces of the world turn and come together in a thundercrack of judgment,' she wrote in her diary when she had slid into a depression after being the target of schoolboys' snowballs. 'There is no reason for the sudden terror, the feeling of condemnation, except that circumstances all mirror the inner doubt, the inner fear.'
The reason for 'the sudden terror', he believes, was that like himself, Plath had inherited a chemical imbalance that cause some kinds of depression just as an imbalance of insulin causes diabetes.
This physical and usually inherited background is by no means the cause of all depression. But it is relatively common, Horder believes - and moreover, the kind of depression that responds most effectively to medication.
As a young doctor Horder had been a Jungian, highly suspicious of the 'immorality of chemically interfering with the mind'. But circumstances converted him to the new anti-depressants launched in the late fifties. With a strong history of depression in his own family, he derived 'enormous comfort' from the recognition that the 'physical pain which gnawed at my life' was inherited, not his fault.
He has always been convinced that Plath had a similar family background. New research bears this out. Plath's father had died when she was 10, but his mother, sister and niece all suffered severe depression.
A few days before Plath's death, Horder prescribed her antidepressants. She was responding well, apparently understanding her struggle against the suicidal depression and reporting faithfully any side effects. But response to such drugs takes from ten to 20 days. At the time of her death, Horder says, she had reached the dangerous time when someone with suicidal tendencies is sufficiently roused from disabling lethargy to do something about it.
Knowing she was at risk alone with two young children he was visiting her daily and making strenuous efforts to have her admitted to hospital. When that failed, he arranged for a live-in nurse. She arrived five hours after Plath had opened the window of the children's bedroom, Sellotaped up the kitchen door, and placed her head on a small cloth inside the gas oven.
As she entered the house, the nurse found a note on the hall table saying: 'Phone Dr Horder' with his telephone number. Does that not suggest that she was expecting, somehow, to be rescued? Not at all, says Horder, who has repeatedly explained to biographers that she could not have been fooling around. 'No-one who saw the care with which the kitchen was prepared could have interpreted her action as anything but an irrational compulsion,' he says. His examination of her body at 10.30am convinced him that she turned on the taps around 4am, the time when the human metabolism is lowest and suicide is most common.
Though her depression was inevitable, her death wasn't. He recalls feeling paralysed forweeks after the death and still wonders whether he could have done more to prevent it. He never read her poetry and did not know of the suicidal subject matter until long after, and is not certain that it would have made any difference if he had.
Certainly her life could have been managed more smoothly. She would not have been alone if her marriage had not come apart. But Horder says that blaming Hughes for her death make sno more sense than blaming Plath.Depression is a condition which affects not just the sufferer but everyone with whom they are in close contact, he says.
The shame, isolation and low self-esteem that drags down the depressed person rubs off on family and friends and inevitably inflicts damage on a relationship. What makes depression difficult to treat is that neither sufferers nor those around them recognise unpleasant symptoms as evidence of illness. Relatives see them as responsible for perpetrating their own misery and blame them for embarrasing the family.
Horder is involved in the current Defeat Depression campaign, organised by the Royal College of Psychiatrists and the Royal College of General Pratitioners, and launched by Prince Charles last year.
No-one should underestimate the task of persuading people that depression is often an illness which needs to be treated with anti-depressants as well as by more fashionable psychological means (see Beyond Belief). At present, ignorance is the root cause of many suicides, according to the Royal College of Psychiatrists. It is possible that Plath would still be alive today if she had consulted Horder earlier and started taking anti-depressants sooner.
Horder will not be drawn into such painful speculation. 'There are too many imponderables,' he says. No-one, however, would dispute that general understanding about depression has increased immeasurably since Sylvia Plath's death.