Submitted by Donna H.

Labaniego, III-B

Summary
In 1956 in Cambridge,United Kingdom, a young poet named
Sylvia Plath meets and falls in love with a fellow poet Edward Ted
Hughes. Sylvia was amazed by Teds genius poetry even before
meeting him and Ted also fell in love with her quickly. As they date
and live together as a couple, Ted finds out about Sylvias past
directly from her. The scar on Sylvias cheek which was noticed by
Ted started the revelation of her story. It was from when she
attempted suicide; she went down to their houses basement and
took too many of her mothers sleeping pills which she puked up
later. She was found by her mother and brother three days later.
She ripped her cheek on the concrete while she was pulled out of
the basement, thus the scar. She has been unhappy and depressed
since her father died when she was 8 years old; the same year she
published her first poem.
The two eventually marry before they went to America. During
marriage, she is living under Teds genius talent as she is trying to
raise her own writing career, which she struggles into unlike Ted.
Sylvia is aware how Ted appeals to other people, especially women,
given his looks and his successful career. Because of these, Sylvia
becomes more emotionally disturbed and suspicious of his
husbands fidelity. She finds out about Teds extramarital affairs
even when they already have two children, making her leave Ted.
She is raising the kids on her own after the separation. She comes
back into writing by using her pain and anger as her inspiration and
somehow gains success as a writer. But still, she is lonely and
exhausted of her situation. She tries to regain what she and Ted had
but she failed. She later on took her life by getting her head inside the oven
(carbon monoxide poisoning) while leaving her two children alive in their wet
cloth-sealed room.
If Sylvia Plath has a psychiatric disorder, I believe it is major depressive
disorder. The symptoms which Sylvia manifested in the movie which fit the
DSM-5 diagnostic criteria for this disorder are the following: depressed mood
(though I cant surely say this happened most of the day and nearly
everyday), feelings of worthlessness or inappropriate guilt (she felt
humiliated by her husband and considered her husband as the real poet in
the house but not her), diminished ability to think or concentrate (her
struggles in writing poems though later she used her sadness and anger to
write poems), and recurrent thoughts of death. These symptoms should be
present during the same 2-week time and should affect the functioning of the
patient in order to fit the Criterion A of major depressive disorder. If only we
could interview Sylvia or the persons close to her regarding the details of her

symptoms, maybe then we we could fit her symptoms in the said criterion.
And we can also elicit from her the other symptoms included in the Criterion
A such as significant weight loss or weight gain, etc and the other criterion
included in the diagnosis of this disorder.
The development of major depressive disorder is not only due to a single
cause, but rather due to an interplay of many factors. Prevalence-wise, there
is a twofold greater prevalence in women than in men. This could be due to
the difference of hormones and pyschosocial stressors and the effects of
childbirth. Also, this disorder are most commonly diagnosed in patients
without close interpersonal relationship and those who are divorced or
separated. As for Sylvias case, though the disorder didnt develop after the
marital separation, this stressful event (plus the stresses of dealing with her
cheating husband even before they finally separated) could serve as a trigger
of her episodes since according to studies, this is the most common
environmental stressor often associated with the onset of an episode. And the
significant life event most commonly attributable to the development of the
disorder is losing a parent before age 11. Sylvia lost her father when she was
9 years and she also described herself as a happy kid until the day her father
passed away. Genetically,studies show that if one parent has a mood
disorder, a child has 10-25% chance of developing such and if both parents
are affected the risk for the child approximately doubles. Also, the risk for
developing the disorder is higher when first-degree relatives are affected. If
Sylvia has a relative with mood disorder, then shes at higher risk of
developing such compared to the general population.
Other than having major depressive disorder, maybe Sylvia also has a
delusional disorder, jealous type or conjugal paranoia where in the delusion is
about the spouse or lover is being unfaithful. In the movie, when Sylvia
started to become jealous and suspicious of Ted having an extramarital affair,
she presents to me as only delusional and paranoid until Ted admitted to
having slept with another woman. Actually, I am also open to the possibility
that because of Sylvia being suspicious, Ted got tired and annoyed by it thats
why he did become unfaithful or that Sylvias suspicions triggered Teds mind
of the possibility of having extramarital affairs. In other words, maybe Sylvias
paranoia preceded that of Teds unfaithfulness. In the case of the second
woman whom Ted is having an affair with, Sylvia was giving meanings to the
simple gestures of Ted towards the other woman. But given that Ted had a
history of unfaithfulness, I couldnt blame Sylvia for being that suspicious
even if she doesnt have a delusional disorder. Again, if we could just
personally interview Sylvia then we can elicit more information that will put
this diagnosis into consideration.
If Sylvias story happened today, her safety must be the top priority
especially when she comes into me after a suicide attempt. Hospitalization
may be necessary to ensure her safety and for her adherence to medications
later on. Complete assessment and diagnostic evaluation should be done for
diagnosis and treatment. Whatever the diagnosis is, the treatment plan
should not only address the immediate symptoms but also should consider
the patients well-being as a whole. If Sylvia has a major depressive disorder,

pharmacotherapy and psychotherapy are the emphasized modes of

treatment. However, we should not also forget to recognize and address the
life stressors of the patient, as this can increase the risk of the patient for
relapses. This could be included in the psychoeducation wherein we can
educate the patient how to handle stresses since these events cant always
be avoided. In Sylvias case, with the strengthening of family and friends
support towards her condition and situation, she can focus more on raising
her children with help from other people and finding affection from her family
and friends.
According to some studies, the use of either pharmacotherapy or
psychotherapy alone is as effective as the combination of both, although
most studies indicate the combination of both as the best treatment for major
depressive disorder. I believe that for Sylvia, she could benefit best from the
combination of two therapies; the pharmacotherapy for the immediate relief
of her depressive symptoms (to balance the neurotransmitters involved in
depression: norepinephrine, serotonin, dopamine, and others) and for the
maintenance or prophylaxis for another episode; and the psychotherapy for
her to deal with the parental loss and marital separation which contributed to
the development and perpetuation of her disorder. Presence of comorbidities,
may it be medical or psychiatric, should be considered as this may affect
treatment selection. Side effects of the medications should also be monitored
and assessed if these warrant treatment discontinuation and consideration of
other medications and treatment modality. Treatment response should also
be monitored to determine treatment failure. Other treatment modality that
can be considered is electroconvulsive therapy (ECT) especially when the
depression is severe and urgent response is needed, and when the patient
becomes repeatedly non responsive to medications. And lastly, follow up
checkups are very important to monitor the progress of the patient.