Art+Mental Health in The Last Confessions of Sylvia P.

Summary, takeaways, art/journal prompts and more from this riveting novel

The Last Confessions of Sylvia P. expands upon the story of The Bell Jar while also telling the fictional story of the appraisal and sale of the lost manuscript. This is a fictional story rooted in a lot of historical autobiography that is told through the lens of three different characters, alternating viewpoints by chapter.

1) Estee is an entirely fictional present-day museum curator who has been given a handwritten copy of The Bell Jar that nobody ever knew existed.

2) Boston Rhodes is a poet based on Anne Sexton who was in a poetry class with Sylvia Plath around the time of the writing of the Bell Jar. Through her we learn a lot about both women’s experiences with depression, balancing motherhood and creativity, and being a female in the male-dominated poet world of the time.

3) And Ruth Barnhouse is a psychiatrist working with Sylvia Plath while she’s in McLean, an autobiographical experience that informed The Bell Jar and therefore the murky bridge between fact and fiction within the book.

The Relationship Between Art and Mental Health: Examples

I read the book once through with just a love for the novel. Then I read it again with a research eye seeking all examples of how the novel addresses the complex relationship between art and mental health. As with all of my work, I looked for both how art serves as therapy for mental health challenges as well as how mental health symptoms impact art and artists. Here are the examples I found …

Robert Frost on Fire

In the early pages of Boston Rhodes’ chapters, she shares the story of meeting Robert Lowell at a party where another older male writer lit his own writing and ultimately himself on fire because of jealousy over Lowell’s writing. The man, we learn, was Robert Frost, and in the novel, when Boston puts the fire out, he says, “I suppose there’s some poetry to dying by the page.” 

This is a small scene in the book, and I don’t know if it’s based on anything that Frost ever really did, but I noticed it immediately in regards to that old cliche about artists and genius and madness. It’s a powerful image: a writer setting themselves on fire because they aren’t getting lauded the way their rival is. And it begs that question of whether that’s because of creative passion or some kind of mental health challenge or both?

If pressed, I’d guess that the character potentially has some kind of bipolar depression, with the fire-setting being a reckless, impulsive manic phase reaction. It reminds me of when the work you’re doing feels like it’s terrible and due to black-and-white thinking you begin to assume all your work is terrible all of the time so you light it on fire … which you may regret when the mania has settled down. In fact, you may regret it so much that you find yourself in a depressive period following that mania.

In actual fact, Robert Frost wasn’t known to experience bipolar depression, but rather lived with major depression (so no mania.) In fact, depression ran rampant throughout his family. His sister and daughter both lived in mental institutions; his sister died in one. His mother and wife were also known to experience depression. His depression was likely not just genetic but also trigger by trauma; his parents died when he was young, he outlived four of his six children, and when his high school girlfriend married someone else it reportedly almost sent him into suicide. “I suppose there’s some poetry to dying by the page,” sounds like a romanticized death wish.

The rivalry between the two men foreshadows the rivalry between Rhodes and Plath that permeates Rhodes’ chapters. They are similar but different and later in the book Rhodes will say, “Is it an exaggeration to say that madness is the thing that joined my orbit’s and Sylvia’s?”

The Mad Poet

Lowell himself is also a patient at McLean under the care of Dr. Ruth Barnhouse where he is called The Mad Poet, again alluding to the tortured artist thing. He’s described in an early chapter as “some sort of poet savant, and very much a lunatic” who has been to the institution three times. 

The non-fictional Robert Lowell lived with bipolar disorder, which can include psychosis in mania, reflected in the description of the fictional Mad Poet as: “He rambles without fences in curling soliloquies of tangential and enlightened word storms.” 

After a variety of treatments - electroshock, talk therapy, opiate medications - the fictional character improves. And although it’s not mentioned what comes to mind is curiosity about the impact of those treatments on his creativity. There is nothing glamorous about the psychosis of mania and the suffering it can entail, but as Kay Redfield Jamison has famously explained fully, there’s a link between hypomania and the early stages of mania and intense creativity. 

In fact, Jamison has written a whole book about the real Robert Lowell and says, “His manias tended to lead him into writing a fresh kind of poetry.” And a Hyperallergic article by Angelica Frey about Jamison’s book elaborates on the relationship between art and mental health for Lowell:

“I write my best poetry when I’m manic,” Lowell is quoted saying in the book. His depression, by contrast, came in handy for thoughtful revisions of poems that had gotten out of hand — a variation on the theme of “write drunk, edit sober.” Mania, wrote Philip Larkin in a letter to Lowell’s third wife upon his 1976 hospitalization, is “the price one pays for being such a rich, inventive and variegated writer.”

The doctor quotes the Mad Poet as saying (though it doesn’t appear to be a real life quote from anywhere): “The line between insanity and art is a verse.” At the end of the book, he will appear again, and the narrator will say of him: “A mild, disinhibiting quality of mania is like mineral spirits to an artist’s oil paints; it loosens the imaginative thought. The problem was it came with violence.”

A Writer Who Can’t Write

In my article about art and mental health examples in The Bell Jar, I shared how towards the end of the novel the protagonist, Esther (based on Plath) experiences a mind-numbing depression that nearly erases her ability to write or even to read. Last Confessions of Sylvia P. picks up around this point, with Sylvia Plath coming to Dr. Barnhouse at this stage. Plath’s mother explains to the doctor that after her writing internship, Plath became depressed and her handwriting began to change:

“It devolved. The letters melted. By the last page, the words were nothing but weak scratch marks.

‘After this summer, Sylvia couldn’t write anymore. She couldn’t read, either. Have you ever heard of such a thing? A writer who can’t hold a pencil or study a book?”

And then she attempted to die by suicide. I can picture the fatigue of depression making it so hard to even hold a pencil that all that comes out are “weak scratch marks.” Depression is also characterized by difficulty concentrating, remembering, and thinking in ways that can limit reading comprehension as well as self-expression.

Dr. Barnhouse decides to approach Plath with alternative therapy; she brings her poetry to read. Plath immediately ignores Yeats, but she picks up Millay, noting that she “suffered from a nervous breakdown, too, if you want to know.” (She will say something similar later in the book: “There’s a terrific tradition of mad artists. Roethke. Berryman. Eliot.”) Then she requests to read James Joyce. At that point, the doctor tried to convince her to write a poem, and she was resistant. She couldn’t ever imagine writing again, she fought the doctor, she refused to even write her name. And yet …

When the doctor returns, she sees that Plath has used the pencil to black out a bunch of words in the Joyce book she’d requested. After a bit of examination, the doctor realizes that Plath left some letters unmarked, and that those letters actually spell out a fresh new poem. It’s blackout poetry! The lines she gives us are lines from the non-fictional Plath’s “Tale of a Tub.” And this is the beginning of her healing process. Her mental health symptoms had prevented her from reading and writing … but it was also reading and writing that ended up being a cure for the symptoms. This complex dichotomy is one of the key truths that seems to exist for many artists/writers with mental health challenges. It’s a delicate balance.

From there, she goes on to give dictation, sharing her observations about another patient while the doctor writes them down, a reference to the real Sylvia Plath’s Miss Drake proceeds to Supper. In another section of the book, Rhodes says of this poem, “It was another strange little poem from our Sylvia, a study in madness and dread, revealed through the behaviors of a mind-crippled asylum patient confronting hindrances, hurdles, and hallucinations.” I would suggest that she was one step removed from dealing with her own internal demons by writing about another patient first. 

We will see this again later, when she pulls herself out of her own depression to help Dr. Barnhouse through writing an eloquent letter about the way Barnhouse helped her; there’s something to this character that allows her to empathetically tune in to other people and deal with emotions through them as a sort of buffer layer to coping with the pain in her own heart … and writing is the medium through which she does that.

Poetry as a Cure for Postpartum Depression

Much of the real life story of Sexton and Plath relates to their era of womanhood, trying to make a creative living as artists while also being housewives and mothers. Rhodes describes the overwhelm of having an infant daughter with croup, how hard it was to stay on top of everything, how she ended up “bed-bound for a whole week” during which the doctor said that her “slide into the depths of anguish was a combination of mania and postpartum depression.” In that state, half-aware of her baby’s crying, she heard a television voice talking about writing sonnets.

She then says, “I’d never written a poem before, but I was bitten, and the inky venom merged with my blood.” This was when she became a poet, and she began to heal from postpartum depression. The structure of a sonnet lends itself well to creative self-expression when you aren’t sure where to start, which can often be the case in the midst of depression. It reminds me of crochet - I and many others I’ve interviewed experienced the benefits of using a crochet pattern as a start to creativity during the worst of depression. It’s too overwhelming to start from nothing but a pattern gets you going. A sonnet’s structure serves sort of as a pattern to follow. The ability to crochet a garment from string or create a sonnet from pen and page can lend itself to increased self-esteem which helps battle the symptoms of depression. Rhodes says:

“I’d spent my whole life living in little rooms. Rooms the shape and size of every role I was supposed to play. Rooms I’d either outgrown or I’d never fit in to begin with. I’d set out to be the best - the best student, the best wife, the best homemaker, the best mother. In the end, I’d failed at them all. But I hadn’t failed at this, at being a poet!”

Pros and Cons of Poetry for Healing

But just because you find a creative cure doesn’t mean that it will always work. Mental health and creativity have a complicated relationship that’s often hard to keep balanced. Later Rhodes shares how complex grief after her father’s death affected her ability to write:

“Ever since my father’s death, I’d only written seven poems. Each was worse than the last. I reworked them until I loathed them, and then I threw them all away. It got so that I wasn’t able to look at a pen, which really scared me. Writing bad poetry was better than producing no poetry at all. …

Poetry moves us, but nobody ever says how it moves us. For some, an absence of poetry leaves them buried alive and running out of oxygen. I worried I was never going to write again.”

This makes me think of The Quandary of Quitting Writing by

Lonely Robot Theme

, which is about how sometimes writing feels hard and we want to quit but doing so only increases the loneliness and hard feelings. Writing can be the problem but it can also be the cure. The worry that she won’t ever write again leads Rhodes to a suicide attempt. She says, “Carbon monoxide filled every inch of the garage, editing the oxygen the same way I crossed out words on a page.” (This line sounds so powerful that I read it over and over.) When she awakes and realizes her attempt was unsuccessful she says, “I decided I was finished with poetry forever. I was through writing it, through studying it, and through competing over it. Poetry had done me in, and it had done me no good.”

But, of course, she’s not done with poetry after all. Her rivalry with Plath spurs her into action when she steals an unpublished poem off the other writer’s desk and begins to finally write again. She transcribes the whole poem that re-writes line after line in her own words. In a sense, she’s doing what Plath had done with the book that Barnhouse gave her - using the frame of someone else’s writing to find her own voice after the despair of deep depression had silenced it. And after this:

“I found I’d entered a new period of unexpected productivity. An unstoppable surge of subjects, scenarios, and motifs came to me. Images appeared in my mind, fully formed and rich with detail. A direct channel had opened between my heart and my mind. Truly, if I’d ever known obsession or the fire of mania, all past experiences failed to match the fervor with which I tore through my rhyming dictionary, mapped rhyme patterns, typed pages upon pages, edited and worked the text.”

Much later, Rhodes will destroy her typewriter in an argument with her husband, then immediately feel like she must get it fixed:

“Without it, I was missing my own fingers, my tongue, my ears. Without it, my roiling inner sea had nowhere to go but rise within me until I could no longer take it.”

Does Writing Hurt or Heal or Both?

What’s the chicken and what’s the egg? Did depression cause Rhodes’ inability to write or did not being able to write exacerbate her depression? Did moving out of depression assist her in getting back to writing or did forcing herself to find a way to write help alleviate her symptoms of depression? In a different chapter, Plath says to Barnhouse that “the pursuit of one’s passions has a corrosive effect.” And yet for both the fictional characters in this book and The Bell Jar and the real people whose lives they are based on, the creation of art continues because somehow it must, somehow it helps … at least until it no longer is enough of a panacea and some of them die by suicide.

We see Plath’s character in the book rise and fall in her healing process as well, and we see how it relates to writing and reading. When a patient she is close to dies, she stops reading again. She only wants to talk about the specific details of the death. “Miss Plath is no longer chasing literary prizes, top marks, or perfection, I fear she is chasing death itself.”

Unable to figure out another way to help her, Dr. Barnhouse requests that The Mad Poet come to visit Plath. He reads poetry to her. He asks her why she can’t read or write and she answers, “I used to be able to, but the words on the pages just sort of merged together. I found myself counting the letters instead. After counting to a hundred or maybe two hundred, I no longer recognized the English language.” She allows him to read some of her poems from before this last dry spell, dismissing their value, but he encourages her:

“These poems are more than just studies of your environment. It seems to me that they are tools designed to expunge the morass in your mind as though it were a kind of poison. It’s a beautiful poison that becomes no less toxic when it touches the page. Except the more you write, the less it will hurt you.”

He encourages her to write again or at least to “write” by doing blackout poetry in a book again as she had done before. She says she can’t, she won’t, then describes the spiraling thoughts when she holds a pen of how she can’t write and maybe won’t ever be a “real writer” and then she’ll never fulfill her potential and so she just wants to kill off that part of herself “with pills, with falls, with rope.”

The ups and downs continue. She gets better. She leaves the institution. She has children. And then years later, she collapses. She begins corresponding with Dr. Barnhouse who says:

“Though she offers few details on the dissolution of the marriage, she admits to a depression that alternates with a manic, boundless fervor. Now each letter to me is full of mourning and melancholia. The impracticality of her life hands all over her. Desperately lonely, she worries about money and putting food on the table. …

Her writing has begun to suffer under renewed insecurity. Barricades stand between her and the twenty poems roosting in her mind. A sanctimonious self-doubt has settled within her. It tells her that her work is flat, far from vital, and lacking surprise. She is terrible. She is a failure. The world has cut its strings of her.”

Then somehow she gets her creative energy back. She begins writing her novel. Either she’s doing better and therefore she’s able to write again or somehow she has found a way to write again and that is helping her to do better.

“Her mood seems to have grown balanced. She reports that she has never felt so peaceful as she does writing seven hours a day, and finds fulfillment in reading Roethke’s poems and stories by Jean Stafford and Eudora Welty. She can see that her writing is coming to fruition after years of work and study, as she continues to eschew the pain of keeping an orderly routine and the home clean, the near-impossible blockade of creativity.”

It all seems better. And then she dies by suicide. Was that a last burst of bipolar mania that allowed her to create that final work? Was it depression that led to death? And the eternal unanswerable question of artists with mental health challenges: was the art worth the pain?

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Our expenses reflect our priorities. Writers should be paid for their work. It’s also true that everyone’s finances are different, which is why I offer a Sliding Scale Pay What You Can annual rate starting at $10.

Art and Mental Health Takeaways:

In summary, from this book we find:

• Hypomania or mania in bipolar disorder correlates with bursts of creativity that sometimes the artist believes could never happen without the condition but this comes at a cost to the artist and to those who care about that person.

• The above is true but also contributes to a continued mythology around the tortured artist that we see many examples of throughout this book. It is a both/and situation … it is true that there’s a correlation between art and mental health challenges AND it is true that either thing can exist separately in an individual.

• Depression can cause an inability to write and even to read. There are many reasons for this including that difficulty concentrating is a symptom of depression. Fascinatingly, handwriting changes are also a mental health symptom.

• It’s hard to tell when the writing / art is creating more of a problem for the person and when it’s helping them to heal. Is it a tool for healing or simply a sign that the person is healing from other reasons?

• When mental health symptoms make it challenging to creatively express oneself, it can be helpful to use a pattern: the structure of a sonnet, the use of blackout poetry, or removing yourself from the equation and writing about someone else.

• Self-esteem is a complex part of the art and mental health equation. Many different mental health conditions create problems with low self-esteem and distorted self-perception. And many artists have their self-esteem tied up in their art/creativity - their own experience of it, the reception of it, the ability to make a living by it. 

• Each of the writers in this book continued to write as much as they could for as long as they could … because they were compelled to do so, because they needed this form of self-expression, because it felt good more than it didn’t … and chances are that this helped them to live longer, richer lives than they might have otherwise. But that alone couldn’t save most of them.

This book brings up so many thoughts for me related to trying to understand the complex relationship between writing and mental health. It really demonstrates the core issue of how interconnected the two are for some of us, and how that is both amazing and devastating. Art is a reason for being, a form of self-expression that connects us to others and gives us purpose, a form of healing that makes us feel better in our darkest times. But also the inability to create art - due to mental health symptoms, self-esteem challenges, life conditions - or even just to create it to the quality and degree we would like can be really challenging for us. Art is so vital to our well-being that when it isn’t working, we become so much worse.

In my experience, it helps to have several different types of creative outlets in order to cope with this. Writing is my primary form of creative self-expression. It’s also my full-time job. This brings all kinds of stuff with it including the self-esteem thing. I write because I have always written, because writing is something I simply must do for reasons I can try to articulate but can never quite convey. But depression has often eaten away at my ability to write … or even if I’m writing, it reduces the healing properties of the writing. I have found that crochet and collage are two things that I can do to keep self-expression moving through and out of me when the words for writing fail. They heal me in different ways. In the book, when Plath found it impossible to read or write, could she have enjoyed painting or knitting or woodworking? Could it have helped her to move out of her mind and into her body just a little bit so that she could begin to heal. I find that we need A LOT of things in our personal toolboxes for healing from mental health challenges.

My experience is as someone who has chronic recurring depression. I have pretty bad bouts of it maybe a couple times a year, but they are short because I’ve gained a lot of skills to cope with them over the years. Despite this, I’ve had two (maybe three, the unsure one being in my teens) periods of double depression which means that I had depression symptoms for over two years consecutively. Because I’ve had these long periods of challenges, and because I suspect they will always return to some degree or another, the need for MANY tools is critical. If writing was my only tool, I’d be at a loss. For that matter, if therapy was my only tool, I’d be at a loss.

There’s often a question for me of how much I should push myself creatively when I’m in deep depression. On the one hand, I know from experience that the routine of getting up and writing, even when it feels impossible, has some magic to it that can potentially help in the healing process. On the other hand, I have had times when I just couldn’t do it and if I beat myself up about it then that made it a million times worse so I had to just be gentle with myself and say that it was okay to not create for a little while. But going too long without expressing myself feels a lot like when Rhodes in the book ruins her typewriter and says, “Without it, my roiling inner sea had nowhere to go but rise within me until I could no longer take it.” Sometimes writing doesn’t make me feel better but NOT writing makes me feel even worse.

I continue to have curiosity about the tortured artist trope. It’s a thing both true and not true. Mania can create amazing work. Mania can also make you so impulsive that you set your work on fire. Ultimately, the book leaves us with the question of whether or not the art is worth the pain. There are people who are grateful for the way that their minds work, including the mania, because even though the lows are low, the highs are so high, and the ability to create within that feeling is amazing. There are also many people who say, including people I’ve interviewed directly, that they would rather be relieved of the suffering of their mental health symptoms and could create more consistently if that were the case. You can be an artist with mental health challenges who experiences remission or recovery of symptoms and still creates brilliantly. But I also have never experienced mania, only depression, so I can only say what seems true from what others have shared.

There’s this great line in the book “All My Puny Sorrows,” that reads: “He had honestly thought music would save her life. Well, said my mother, it probably did while she was alive.” And this comes to mind in this book because maybe Rhodes and Plath were destined somehow to die by suicide but writing extended their lives and gave it richness for as long as it could. Is it possible that they could have instead been healed completely and lived long lives? Maybe. If so, they wouldn’t have been the same people they were, though, and their art would have been different. That’s neither good nor bad but does seem true. That’s what I’m mulling as I wrap up the second reading of this novel.

Art and Journal Prompts:

I offer you some creativity prompts that you can use for journaling, creative writing, as a start to an art project, or however you may see fit:

• Start a story or create a piece of art inspired by the phrase: “I suppose there’s some poetry to dying by the page.”

• Make a list of artists with mental health challenges. The list from this book alone includes Frost, Lowell, Plath, Sexton, Millay, Roehtke, Berryman, and Eliot. Choose one and write or draw your impressions of that artist.

• Try your hand at writing a sonnet.

• What are the “little rooms” that you live in? Describe or draw them.

• Choose one of the book’s quotes shared throughout this article and respond to it.

• Consider: when has your creativity helped you and when has it harmed you?

Related Tips for Using Creativity to Improve Wellness:

In addition to the above prompts, you might want to try some of these creative activities to help improve mental health:

• Grab a book or magazine and create some blackout poetry.

• Join an art / writing class or group to gain the benefits of camaraderie. 

• Use poetry for meditation.

• If you have journals or old letters you’ve handwritten, go back and see how your handwriting changes depending on your mood. Use this as a key in the future to understanding what’s going on with you emotionally when you see your writing change.

• Learn a new art/craft. It’s so important to have multiple creative healing tools in our toolboxes.

• Create a personal brag book of your creative accomplishments. Mine includes emails or texts from people who have said things about my work that touched me, favorite pieces I’ve written or crocheted, a few awards (but not all because the key is that the things has to make YOU proud, regardless of what it says to others.) The point here is that whenever you’re struggling with creative self-esteem, you can look at this book/file/box and remember what you love about your creative self.

Related Tips for Coping with Mental Health Symptoms That Impact Creativity:

Do you have symptoms that are impacting your ability to create? Here are some additional wellness tips:

• Start and end your day with something that you find soothing and grounding. You might even try reading a poem every day as part of that ritual.

• Volunteer or find a way to help someone else. In the book, we see how getting outside of her own brain and focusing on someone else helps Plath.

• Find the form of therapy that works for you. In the book, Dr. Barnhouse brings a nontraditional approach to the patients, trying many different things outside of meditation and talk therapy. There are many forms of therapy and not all will be the right fit but your right fit is out there.

Affirmations, Quotes, Etc.

Just a few more of the quotes I loved in this book:

• “Her memory endures on a tapestry strewn with holes. Each of us is subject to the acidity of grief. It eats away at the truth.”

• “Meaning making is the coping mechanism of the hopeless.”  Note: I don’t resonate with the word hopeless but I do think meaning making is a critical response to trauma.

• “Despite the science and methodology of psychoanalysis, the controlled inroads we make into the cradle of thoughts and behaviors, the measures that allow us to life the mad from the wet fog of their psychosis, there is and will always be, due to the unknowable makeup of the mind, a glorious mystery to human nature.”

Affirmations from Plath’s own writing:

Reading or writing affirmations / mantras can be very powerful. Here are a few to try, all from Plath’s The Bell Jar.

• “I am, I am, I am.”

• “Remember, remember, this is now, and now, and now.” 

• “I shut my eyes and all the world drops dead; I lift my eyes and all is born again.” 

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