Esther sits in Dr. Gordon's office, wearing clothes that have not been washed for three weeks. She has not washed her hair for three weeks and she has not slept for seven nights. She immediately takes a dislike to the doctor, thinking him conceited. He asks her to tell him what she thinks is wrong, but she omits certain details. She does not tell him one of her most alarming symptoms, that when she tried to write to Doreen, she could not form the letters properly. Dr. Gordon appears to reach no conclusions, merely shaking Esther's hand at the end of the session and saying that he will see her the following week.
One day, walking on the Common, Esther meets a young sailor. She tells him her name is Elly Higginbottom, and that she comes from Chicago. She also tells him she is thirty years old and an orphan. He comforts her as she cries.
At her next appointment with Dr. Gordon she says she has not slept for fourteen nights, and she cannot read or write or swallow very well. Dr. Gordon arranges to speak to her mother, and she tells Esther that the doctor thinks she should have electric shock treatments at a private hospital.
Esther spends more afternoons in the park. She still cannot read well, and buys a tabloid newspaper because the paragraphs and stories are short and she can read them. Reading about a man who was persuaded not to commit suicide, she wonders how many stories of a building you would have to jump from in order to ensure death. She decides on seven. Knowing that the next day she must go to the hospital, she thinks of running away to Chicago. She goes to the bus station but then realizes that it is already mid-afternoon and her bank will be closed, so she will be unable to withdraw any money to pay her fare. Instead, she takes a bus home.
She goes to the hospital and is taken to a part of the building where the windows are barred. A nurse and Dr. Gordon prepare her for the electric shock treatment. The doctor fits two metal plates on either side of her head, and gives her a wire to bite on. There is a blue flash and she is jolted by the electric shock until she feels her bones would break.
After the treatment she sits in a wicker chair, remembering an incident from earlier in her life when she received an electric shock from a lamp at home. When Dr. Gordon inquires how she is, she replies that she feels all right, even though she feels terrible. The doctor tells Esther's mother that after a few more shock treatments, there will be a great improvement in Esther's condition. Going home with her mother, Esther feels dumb and subdued and tells her mother that she will refuse to return for any more treatments. Her mother seems pleased, thinking that Esther has simply decided she is going to get better.
At this point Esther decides to commit suicide. She has not slept for twenty-one nights. One morning, she locks herself in the bathroom, runs a tub full of hot water and takes out a Gillette blade, intending to cut her wrists. But she cannot bring herself to do it, having the courage only to make a small cut in her calf, which she then bandages. Later that morning, she takes a bus to Boston, and then another bus to near the Deer Island Prison, where she walks along the beach and talks to a prison guard who has an observation booth there.
She sits on the beach wondering what to do. She contemplates drowning herself, but as the incoming tide washes over her feet, she realizes that she lacks the courage to do so.
Esther's depression deepens. She sees no point in doing anything, even basic things like washing her clothes and hair. There seems to be no purpose in life at all, and she wonders why anybody bothers to do anything ("everything people did seemed so silly, because they only died in the end"). These are classic signs of depression, and Esther conveys exactly how it feels. It is "as if I were being stuffed farther and farther into a black, airless sack with no way out." And again: "Every time I tried to concentrate, my mind glided off, like a skater, into a large empty space, and pirouetted there, absently." The novel could almost be used as a textbook for symptoms of depression. It also reveals, in the attitude of Esther's mother, a common belief that depression is just something one can "snap out of" if one wants to. Her mother thinks that Esther could simply make a decision to get well and she would be fine. But depression is in fact an illness that can no more be wished away than a serious physical illness can be banished by pretending it does not exist.
The electric shock therapy Esther receives was commonly used in the 1950s, and was found to be effective in the treatment of depression and other mental disorders. Sylvia Plath herself received such treatments, and the novel closely follows her own experience. During the 1960s and 1970s, however, there was a backlash against shock therapy, prompted by the discovery that it was often misused in mental hospitals to control rather than cure the patient. However, electric shock treatment is still used in America today.