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SYLVIA PLATH

A DIFFERENTIAL DIAGNOSIS
Elainna Simpson
SYLVIA PLATH 8/27/1932 - 2/11/1963

Þ A confessional poet and author: “fated to become insane” after a “rather brief and
posthumous Pulitzer Prize traumatic experience of badly-given shock treatment”
“pretty soon the only doubt in my mind was the
ÞFather died when she was 8, mother and precise time and method of committing suicide”
her had a difficult relationship. -letter to a friend
ÞFrequent self harm and suicide ideation –
after internship “I am terrified by this dark thing that sleeps in me.” 
ÞWas formally diagnosed with depression “Dying is an art.
when she was 20 after a suicide attempt. Like everything else,
I do it exceptionally well.
ÞTreated at psychiatric hospital -ECT I do it so it feels like hell.
I do it so it feels real.
ÞMarried to Ted Hughes ended in I guess you could say I have a call.”
separation due to infidelity by him -Poems
ÞSuicide at the age of 30
SYMPTOMS
ÞSelf harm & Suicidal Ideation/Attempts “Is there no way out of the mind?”
ÞInsomnia
ÞIssues with keeping friends/boyfriends “I desire the things that will destroy me in the end.”

Þ2 opposing personalities: Bright and successful or isolation and


emptiness “I don’t care about anyone, and the feeling is quite
obviously mutual.”
ÞEmotional Instability
ÞOutbursts of anger
“If I didn't think, I'd be much happier; if I didn't have any
ÞRacing thoughts sex organs, I wouldn't waver on the brink of nervous
emotion and tears all the time. ”
ÞTimes of productivity in writing and times of decreased productivity.
ÞDepressed mood
“Think. You can. You must, moreover, not continually run
ÞInability to manage life/cope away while asleep- forget details- ignore problems- shut
walls up between you and the world and all the gay
ÞIntense emotions bright girls-: please think –snap out of this.”
MAJOR DEPRESSIVE “Can you understand? Someone, somewhere, can
you understand me a little, love me a little? For all

DISORDER
my despair, for all my ideals, for all that — I love
life. But it is hard, and I have so much — so very
much to learn.”

A. 5 or more, during 2 weeks 9.Recurrent thoughts of death or suicidal ideation


1. Depressed Mood
• “have a lot to do but I am sick and sad” •“I want to kill myself, to escape from responsibility, to crawl back
• “is anyone really happy?” cannot fathom happiness abjectly into the womb. I do not know who I am, where I am
2. Loss of interest or pleasure going,- and I am the one who has to decide all these hideous
questions. I long to escape from freedom- I am weak, tired, in revolt…”
3. Significant weight loss or weight gain
• lost 20 lbs, was gaunt, could eat when given something. B. Significant distress or impairment in social, occupational, or
4. Insomnia or hypersomnia nearly every day other areas of functioning
• “I wonder why I don't go to bed and go to sleep. But then it would
be tomorrow, so I decide that no matter how tired, no matter • In her journal she speaks on struggling to maintain a
how incoherent I am, I can skip on hour more of sleep and live.” social, academic, and personal life without going into
5. Psychomotor agitation or retardation nearly every manic depression.
day
6. Fatigue or loss of energy every day C. Not due to substance abuse or medical condition
7. Feelings of worthlessness or excessive or • No apparent effects of medical condition or substance
inappropriate guilt nearly every day
8. Diminished ability to think or concentrate or D. There has never been a manic or hypomanic episode
indecisiveness, nearly every day. • No. Bipolar not added to DSM until 1980
• Racing thoughts: “Loss of perspective humor. Colossal desire to escape, retreat
not talk to anybody. Thesis panic- lack of other people to be with fear, big and
ugly and sniveling.”
BIPOLAR II  “It is as if my life were magically run by two
electric currents: joyous positive and despairing

DISORDER
negative—whichever is running at the moment
dominates my life, floods it.”

A. At least 1 hypomanic episode & 1 depressive episode. Not Depressive Episode:


severe enough for hospitalization. 1. 5 or more from last slide
Hypomania Episode:
1. Abnormal or persistent irritable mood, increased goal- B. There has never been a manic episode
directed activity or energy lasting 4 days, present every day.
C. Occurrence of hypomanic episodes
2. 3 or more not better explained by schizophrenia
a. Inflated self esteem
• “Kiss me, and you will see how important I am.” D. The symptoms of depression or
b. Decreased need for sleep unpredictability of mood changes
c. More talkative than usual or pressure to keep talking causes clinical significant distress of
d. Flight of ideas or subjective experiences that thoughts are racing impairment to social, occupational, or
e. Distractibility other areas of functioning.
f. Increase in goal-directed activity or psychomotor agitation • “I have the choice of being constantly active
• Would write more at one time and happy or introspectively passive and sad.
g. Excessive involvement in activities with high potential for painful Or I can go mad by ricocheting in between.”
consequences
• Skiing dangerously, driving her car off the road, etc.
BORDERLINE “If you expect nothing from

PERSONALITY DISORDER
somebody you are never
disappointed.”

A. Pervasive pattern of instability of interpersonal 5. Recurrent suicidal behavior, gestures, or threats or


relationships, self-image, and affects marked with self-mutilating behavior
impulsivity. Onset early adulthood. 5 of the following: • Frequent self-harm and suicidality
1. Frantic efforts to avoid real or imagined abandonment 6. Affective instability due to a marked reactivity of mood
• Felt loss of emotional comfort of a dad, ended relationships with • “I have the choice of being constantly active and happy
boyfriends for no apparent reason. or introspectively passive and sad. Or I can go mad by
2. A pattern of unstable & intense interpersonal ricocheting in between.”
relationships, alternating to extremes of idealization and • She talks about crying and being emotional a lot
devaluation. 7. Chronic feelings of emptiness
• She was noted for emulating her husband often and being all  “Outcast on a cold star, unable to feel anything but an awful
consumed by him. “ted is my salvation, how could anyone else helpless numbness. I look down into the warm earthy world.
stand me?” Into a nest of lovers’ beds, baby cribs, meal tables, all the
3. Identity disturbance: persistently unstable self-image or solid commerce of life in this earth, and feel apart, enclosed
sense of self in a wall of glass.”
• At some points she is very confident and others she is very self- 8. Inappropriate intense anger or difficulty controlling
conscious about her body, her looks, and her abilities anger
4. Impulsivity in at least 2 or more areas of potential self- • She was known to have angry outburst
damage 9. Transient stress-related paranoid ideation or severe
• She skied dangerously and would drive off of the road dissociative symptoms.
MOST LIKELY:
Bipolar II with the addition of borderline personality
disorder.
Mostly bipolar II: Not extreme enough to always inhibit
her functioning only after a large stressor (sexual assault,
separation from Ted). She has clear mania and depressive
episodes.
Partly personality: Sylvia seems to have grown up with a
mother who encouraged her personality traits and a
situation where borderline personality symptoms make
sense.
TREATMENT
Bipolar II Borderline Personality
Þ Medication to stabilize mood ÞPsychotherapy: reduce impulsivity,
work to improve relationships
ÞPsychotherapy: talk through the
issues and allow a relationship that ÞDBT: group and one-on-one,
teaches you how to control your relationship with therapist, practicing
feelings: self-harm and suicidality, skills, rework assumptions, control
issues with parents, depressive distress: interpersonal issues, anger,
moods, racing thoughts abandonment, self-image, self-harm
ÞCBT: identify and change unhealthy
behavior: Self-harm and suicidality
ÞECT: worked for her when done
correctly