B17 Word Version – Les Belles Images – A Literary Diagnosis

Introduction

Les Belles Images: A Diagnosis in Literature                                               (Simone de Beauvoir: 1966)

by Timothy Brook,  Ailsa Campbell, Joanna Moffatt, Rufus Turner, Zoe Johnston

As second year medical students at the University of Edinburgh,  we have had the opportunity to study a topic of our choice. Our group had a shared interest in French language and culture, and we all wanted to do something outwith our usual field. We collaborated with the French department and Dr Jane Yeoman kindly accepted our request to act as tutor. We also contacted Dr Lucy Stirland, a psychiatrist who had previously undertaken a similar project. She has had a keen involvement in the project and has been an invaluable professional advisor.

Dr Yeoman suggested a number of possible texts to look at, including Simone de Beauvoir's Les Belles Images. The author was a prominent female figure in French literature, feminism and philosophy, which we thought would add depth and colour to our studies.

It became apparent that we could work from an original perspective: a medical one. We drew on each other’s ideas to come up with key themes and points of interest. Through further meetings we began to formulate a clearer plan for our project: we would assess the mental health of the main character, Laurence, and suggest explanations for our diagnosis. We used quotations from the text to support our arguments.

We agreed on the following objectives:

 To view and understand mental health from a new perspective, giving us an insight in to the mind of the layperson

 To examine the portrayal of mental illness in a celebrated work of literature To develop our understanding of critical literary analysis To broaden our knowledge of mental health problems To improve our varying levels of French and our understanding of the language

as a whole

In order to achieve these objectives, we set out two fundamental aims, reflected in the key sections of our project:

1. What is Laurence’s diagnosis?

2. What are the potential causes for her mental health condition?

We hope that you enjoy our interpretation of the book as much as we have enjoyed reading it.

QUOTE TRANSLATION AVAILABLE HERE

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This site was made by a group of University of Edinburgh medical students who studied this subject over 10 weeks as part of the SSC. This website has not been peer reviewed. We certify that this website is our own work and that we have authorisation to use all the content (e.g. figures/images) used in this website.

Introduction to Diagnosis

Using Les Belles Images as an insight into Laurence’s life, we can extrapolate a medical history. Having read and applied diagnostic literature to this, we have developed a provisional differential diagnosis for Laurence, examining three key areas: mood disorders, anxiety disorders and eating disorders.

Differential diagnosis

Mood disorders: Depressive episode (AKA ‘clinical’ or ‘major’ depression), Dysthymia, Cyclothymia, Bipolar disorder, Multiple Personality Disorder

Anxiety disorders:   Panic Disorder, Obsessive-Compulsive Disorder (OCD), Post-traumatic Stress Disorder (PTSD), Social Phobia/Social Anxiety Disorder, Specific Phobias, Generalised Anxiety Disorder (GAD)

Eating disorders: Anorexia, Bulimia

Mood Disorders

Depression

The term ‘depression’ is used to describe many emotional states and medical conditions. A depressive episode, or ‘clinical depression’, is characterised by at least one of the following symptoms being present most of the time, for at least two weeks:1, 2

Persistent sadness or low mood; and/or

Loss of interests/pleasure

Fatigue

These may be accompanied by the following symptoms:

Reduced concentration or indecisiveness

Reduced self-esteem/confidence

Guilt, self-blame or unworthiness

Bleak and pessimistic views of the future

Ideas or acts of self-harm or suicide

Disturbed sleeping pattern

Altered appetite

Severity is classified as:

Not depressed: <4 symptoms

Mild depression: 4 symptoms

Moderate depression: 5-6 symptoms

Severe depression: ≥7 symptoms

Dysthymia

Dysthymia is a related condition, consisting of chronic depressed mood for at least two years, but without sufficient symptoms to be classified as a depressive episode.2 Dysthymia may be the patient’s default state for the majority of their adult life and can, therefore, cause significant distress and disability. In contrast to a depressive episode, dysthymic patients experience milder symptoms for a longer period, and can usually fulfil day-to-day requirements. Dysthymia often remains a variable subclinical condition, and depressive episodes may occur over a basal dysthymic state.2

Alternative Diagnoses

The first explicit example of Laurence’s depressive nature appears at the beginning, where Laurence claims: “je suis cyclique”(p.8), which is somewhat exaggerated in the English translation as: “I am a manic-depressive”(p.8).  Bipolar disorder, formerly known as manic depression, is characterised by alternating periods of depressed and elated mood.2 Although Laurence occasionally experiences elation, such as: "dans les veines...une coulée brûlante"(p.101) during sex, these are inconsistent with the longer periods of hyperactivity, ecstasy and energy characteristic of a manic episode. We also see the narration alternate between the first and third person, although this is more likely to represent Laurence's sense of detachment, rather than multiple personality disorder.

Laurence’s description of herself as "cyclique" suggests a diagnosis of cyclothymia, a chronic persistent instability of mood, with periods of mild depression and mild elation. Contrasting Laurence’s experience of "aigres déchirements, une certaine irritation, une certaine désolation, du désarroi, du vide, de l’ennui"(p.36) with her "chavire de désir"(p.101) with Jean-Charles, supports this diagnosis. In cyclothymia, however, ‘mood swings are usually perceived by the individual as being unrelated to

life events’.2  It is clear that Laurence’s mood is occasionally linked to significant life events, exemplified by her "explosion de joie’(p.153) when invited to Greece with Papa, and her despair arising from Jean-Charles’ reaction to the car accident. Overall, it is clear that Laurence does not fulfil criteria for either bipolar disorder or cyclothymia, making a diagnosis of dysthymia and depressive episodes more plausible.

Evidence of Dysthymia

Throughout the book there is evidence indicating a diagnosis of dysthymia. Laurence suffers from symptoms suggestive of a depressive episode, but without sufficient severity as to impede her day-to-day activities. She appears to flourish at work, attends parties and sustains a relationship (however imperfect) with Jean-Charles. Her depressed mood appears relatively mild, not causing ‘clinically significant’ impairment in her work or social life. Nevertheless, symptoms of worthlessness and guilt are exemplified through her fears about Catherine: “Faudra-t-il qu’elle devienne une femme comme moi”(p.122) and her repeated rhetorical questioning of “qu’ont-ils que je n’ai pas?”(p.14,19).

Also, Laurence frequently demonstrates apathy towards otherwise enjoyable activities: “Pourquoi suis-je incapable d’aimer des choses que je sais dignes d’amour?”(p.168). She claims “J’ai l’impression d’être distraite en général”(p.37), describes her position as “un gouffre d’indifférence”(p.167) and expresses her disinterest in a previous pastime: “la littérature ne me dit plus rien”(p.43). Laurence claims to be in a "cercle vicieux"(p.43), and her chronic apathy, pessimism and sense of detachment is illustrated when she states "il me semblait n’avoir plus d’avenir...je me négligeais, je m’ennuyais et je me sentais de plus en plus dépossédée de moi"(p.43).

Evidence of depressive episodes

After Dominque speaks flippantly of suicide, Laurence contemplates the issue in relation to her own experience of five years ago, decribing: "ce creux, ce vide, qui glace le sang, qui est pire que la mort bien qu’on le préfère à la mort tant qu’on ne se tue pas"(p.85). Despite lack of explicit detail, we can infer that she was suffering a depressive episode.

In the final chapter, there is evidence that Laurence is suffering from another acute depressive episode, above and beyond her usual symptoms and impeding her daily life: “Je n’en peux plus!”(p.168). The onset of this episode appears to occur during her trip to Greece. Additional symptoms of fatigue appear, such as "une grande fatigue...dans le corps et dans l’âme"(p.167), and a further sense of detachment, apathy and loss of concentration, particularly where Laurence claims “je recontrais la beauté, et je ne trouvais rien à en faire”(p.161).On her sickbed at home, her pessimism worsens as "elle s’abandonne à la nuit"(p.169) and she refers again to her exhaustion, lamenting her lack of friendships.

Symptoms are usually present for at least two weeks in a depressive episode,2  and although the timeframe of Laurence’s downturn is unclear, her family’s worry indicates that it lasted for a significant time. Together with her disturbed eating and sleeping, Laurence fulfils the criteria of a depressive episode.

Eating Disorders

In literary analyses of Les Belles Images, Laurence is often referred to as anorexic.3 The French "anorexie" is used in the novel (p.169), however the medical condition ‘anorexia nervosa’ encompasses more than simply not eating.

Diagnostic criteria include:4

Body weight 15% lower than expected, or BMI <17.5 Self-induced weight loss Body image distortion with a fear of fatness despite being thin Endocrine disorders Delayed/arrested puberty

Food avoidance is based upon body image and fear of fatness,4, 5  which is common to both anorexia and bulimia nervosa. Bulimia, however, is characterised by disordered eating behaviour, commonly recurrent binge eating followed by self-induced vomiting or use of laxatives. Patients are usually approximately normal weight due to binge eating, and so tend not to suffer the endocrine disturbances associated with  low body weight seen in anorexia. The causes of both conditions are similar, with psychosocial factors affecting the patient’s attitude towards food.4

The SCOFF questionnaire is often used to aid diagnosis*:4, 5

Do you make yourself Sick because you feel uncomfortably full?

Do you worry you have lost Control over how much you eat?

Have you recently lost more than One stone in a 3 month period?

Do you believe yourself to be Fat when others say you are too thin?

Would you say that Food dominates your life?

*≥2 ‘yes’ responses indicates a likely case of anorexia nervosa or bulimia.

Evidence in Les Belles Images:

Simone de Beauvoir makes several references to eating habits, particularly relating to Laurence’s emotional state. Some are suggestive of eating disorders, but many are more akin to anxiety.

Immediately after discovering Gilbert’s affair with Patricia, "elle en sueur soudain, elle a envie de vomir"(p.48). The first situation in which Laurence actually vomits, however, is when she discovers that her mother has written to Patricia about Gilbert’s affair with Lucile: “un spasme lui déchire l’estomac, elle vomit tout le thé qu’elle vient d’absorber”(p.121). This reaction could be seen as a response to losing control of the situation, often a major factor in eating disorders. She also displays a desire to feel empty here. This behaviour, however, is more likely to be a stress reaction, with Laurence describing: “une peur panique”(p.121), which would be more consistent with anxiety.

As her emotional turmoil comes to a head in the final chapter her disordered eating behaviour becomes most obvious.

“Deux jours qu’elle n’a pas mangé. Et après? Puisqu’elle n’a pas faim... Elle a vidé la tasse, et son cœur se met à battre, elle se couvre de sueur. Juste le temps de se précipiter à la salle de bains et de vomir; comme avant-hier et le jour d’avant. Quel soulagement! Elle voudrait se vider plus entièrement encore, se vomir tout entière"(p.168-9)

She displays anorexic behaviour by refusing to eat and purging when she does, but her lack of hunger is inconsistent with an eating disorder, where the patient still feels hunger but overcomes it. She describes again a desire to feel empty, a common finding in eating disorders.5 Furthermore, the doctor “a parlé d’anorexie”(p.169) when he was consulted about this episode.

In contrast to these episodes, when she is happy with her father in Greece Laurence describes her carefree attitude to food: “je mangeais avec appétit et indifférence”(p.156). Food is mentioned frequently in this chapter, with Laurence using it to describe her surroundings:“ces taxis grecs ont d’étranges couleurs de sorbet au cassis, de glace au citron”(p.155), and discussing happiness in relation to food:“[Le bonheur] m’enveloppait tandis que nous mangions du mouton grillé”(p.155).

Alternating between the first and third person is a key literary feature of the book. Her use of the first person when she is enjoying Greece with Papa, and is eating heartily, demonstrates an emotional attachment to food. This changeability of eating habits with mood, however, is more consistent with anxiety than an eating disorder. In anxiety, acute phases of panic can cause nausea which prevents eating and when these subside eating habits return to normal.

Furthermore, using Les Belles Images to answer the SCOFF questionnaire from Laurence’s point of view would give a score of 0-1, arguably responding “yes” to the final question and “no” to the others as there is no indication of body weight or uncontrolled eating.

Sociological explanations of eating disorders often describe the patient substituting control over certain aspects of their life with weight control. This agrees with E. Fallaize’s interpretation that Laurence refuses to eat as a form of revolt against manipulation by others, and we see that the vomiting stops when she finally makes a stand for herself.3 Perhaps Simone de Beauvoir was intending to portray Laurence as anorexic in order to highlight her reaction to oppression in the 1960s, but with anorexia being a ‘new’ condition at the time,6 her understanding of the it meant that she could not portray anorexia in a way that meets today’s criteria.

Overall, Laurence does not meet the standard diagnostic criteria for eating disorders, presenting very little concern over body image or weight.

Anxiety

Anxiety disorders are a set of conditions involving disproportional fear or worry.5 Of these, Panic Disorder is most applicable to Laurence’s case. It is a condition where the sufferer experiences intense panic, with associated sympathetic (fight or flight) symptoms, and also worry about when or how such  episodes may affect them. These can be related to a specific cause, or can occur without warning. In addition to the patient history, diagnosis requires symptoms persisting for longer than one month, and presence of risk factors.

RISK FACTORS:6

History in first-degree relatives Aged 20-30 Female White ethnicity Major life events Comorbidity Psychological factors

Laurence is a white female, “d’une trentaine d’années”7 and, although not diagnosed, Dominique shows symptoms of borderline personality disorder (BPD) and takes “les barbituriques”(p.52). Diagnosis of BPD requires the patient to display six out of nine pervasive traits without biological explanation. These traits include ‘frantic efforts to avoid real or imagined abandonment’; ‘identity disturbance – markedly and persistently unstable self-image or sense of self’; and ‘chronic feelings of emptiness'.8 As discussed previously, there is evidence that Laurence also suffers from a depressive co-morbid disorder.

Key Symptoms:6

Avoidance

Apprehension and worry

Reliance on safety cues

Nausea/abdominal pain

Unexpected panic attack

Depersonalisation

Avoidance is a tendency to evade activities which may cause panic attacks.6 For Laurence, these situations tend to centre around her mother:“demander quelque chose à sa mère l’intimide autant que lorsqu’elle avait quinze ans”(p.14).

Apprehension manifests as physical symptoms, including a fear of dying or not being able to breathe, and psychological symptoms such as a fear of losing control.6 Laurence never seems to have the former, but she does worry about losing control - particularly where Catherine is concerned. She also shows concern that she may pass on her anxiety issues to her. “Anxiété, remords. Les humeurs quotidiennes…toutes ces contingences qui devraient s’effacer derrière moi, ça s'inscrit dans cette enfant”(p.135).

‘Reliance on safety cues’ indicates an elevated level of reliance on certain people or on medications to help sufferers cope with social situations or to remain calm.6 Unlike Dominique, Laurence does not take tranquillisers routinely, only doing so when she panics, to clear her mind or sleep - “avant de se mettre au lit elle prend un cachet.”(p.120).

Nausea and abdominal pain are common symptoms in panic disorder.6 Sufferers can describe a feeling of knots in their stomach, a lump in their throat (globus hystericus) and difficulty eating, or vomiting. These symptoms were consistently present in Laurence’s history: “Mais ce noeud dans ma gorge m’empêche de manger”(p.153). This struggle to eat or keep food down is often attributed to anorexia, however, the context is more suggestive of anxiety.

The unexpected onset of panic attacks is another common feature of panic disorder.6 There is evidence in the book that Laurence suffers attacks of this nature, with episodes of somatic symptoms that escalate quickly and unpredictably. An example of such a panic attack is when Laurence sees her mother after being attacked by Gilbert: “L’horreur prend Laurence à la gorge… Ah! Toutes les images ont volé en éclats, et il ne sera jamais possible de les raccommoder.”(p.124).

Depersonalisation is the feeling of losing a sense of self.6 We see this in Laurence’s case as she often switches to referring to herself in the third person, mostly when discussing difficult situations. A feeling of detachment could be a coping mechanism, particularly because she seems to see herself as two different people - the person she wants to be and the person she is forced to be by those around her.

Laurence’s symptoms meet the criteria for panic disorder and the fluctuating nature of her condition also contributes to this conclusion.

Summary of Diagnosis

Diagnosis:

Dysthymia Superimpositions of Depressive Episodes Panic Disorder PHQ Analysis

To further evidence our conclusions, we decided to fill out a PRIME MD Patient Health Questionnaire from Laurence's perspective. This would be a routine investigation for a patient presenting with symptoms of a mental health disorder. Copies of the questionnaire, and the marked results, can be found here.

The results suggested that Laurence:

Suffers from moderately severe depressive disorder, but does not have major depressive disorder

Suffers from a somatoform disorder with a high degree of somatic symptoms (PHQ 15)

Suffers from panic disorder with severe anxiety (GAD 7)

Does not suffer from an eating disorder

Her PHQ 2 and GAD 2 results both suggest screening

Her PHQ 9 result recommended "Immediate initiation of pharmacotherapy and/or psychotherapy"10

These results concur almost entirely with our findings, but it is important to remember that this test is not entirely qualitative. It cannot, therefore, be used in isolation and should be combined with a thorough patient history and examination.

Introduction to Causes

The cause of mental health problems such as depression and anxiety are usually complex

involving biological and environmental factors, with episodes often triggered by stressful

events such as bereavement, illness or divorce. To aid the understanding of how patients

have come to be the way they are and what shapes their thoughts and feelings, psychiatrists

often use a tool called the psychiatric formulation [see appendix].1 This can be presented in a

table distinctly indicating the biological, psychological and social factors that pre-dispose,

precipitate, perpetuate and protect the patient from their condition.1 We have chosen to use

this structure to examine the aspects of Laurence’s life, portrayed by Simone de Beauvoir in

Les Belles Images, which may have led to the development of her mental health problems

and final depressive episode.2

Biological Factors

(Predisposing)

Biological factors affecting mental health can include hormonal, genetic and neurological influences. Laurence’s age, gender and race predispose her to mental health problems. The strongest biological factor that we can determine is genetic, with Dominique displaying characteristics of borderline personality disorder. This can be seen by her unstable sense of identity: “qui imite-t-elle?”(p.34), “derrière les images…qui se cache? Peut-être personne du tout.”(p.17). Family history is a significant risk factor for mental health disorders and thus Laurence’s risk is already markedly increased.3

Psychological Factors

1) Poor Maternal Relationship in Childhood (Predisposing)

Laurence was raised predominantly by her mother, whose behaviour would have had a psychological impact on her: “c’est mon père que j’aimais et ma mère qui m’a faite”(p.33). We can see that Dominique was oppressive and focused on appearance: “Elle a toujours été une image. Dominique y a veillé”(p.21). Here "elle" refers to Laurence; as discussed in the diagnosis section, the use of “je” and “elle” when Laurence is narrating gives a sense of depersonalisation. This technique also encaptures Laurence’s struggle between her own ideas and the need to conform to the expectations of those around her.

As a child, Laurence was not allowed to have close friends: “Marthe a eu une amie… Moi non. Jamais.”(p.55). Childhood social withdrawal is an important risk factor for developing depression in early adulthood.4 Furthermore, she appears to lack an emotional connection with her mother, describing her as "une étrangère"(p.17) who made her feel nervous even as an adult: "demander quelque chose à sa mère l’intimide autant que lorsqu’elle avait quinze ans."(p.14). This suggests that Laurence was brought up in an environment where she could not fully express her emotions, thus could be considered a pre-disposing factor to her depression and anxiety. Poor maternal attachment is a recognized potential cause of mental illness in adulthood.5

This idea is supported by de Beauvoir, who describes this novel as different to her others: rather than the characters expressing their opinions explicitly, in Les Belles Images "il s’agissait de faire parler le silence".6

2) Divorced Parents and Distant Father Figure (Predisposing)

Laurence’s lack of paternal input due to her parent's divorce may also have contributed to her inability to express herself. Divorced parents are a common feature of people with psychiatric pathologies, including the internalisation of problems.7

‘Attachment theory’ may further explain Laurence’s relationship with her father. This psychodynamic model is used to describe how humans respond to separation from loved ones, pain, or perception of a threat by seeking intimacy, approval and responsiveness in later relationships. In Laurence’s case, the distance from her father in childhood may form the basis of her idolisation of him.

3) Laurence’s Concerns About Catherine (Precipitating)

From the outset, we understand that Catherine is not happy:“[elle] a du chagrin, la nuit elle pleure”(p.8). We learn that this is due to her realization of  suffering,  She asks existential questions: “pourquoi est-ce qu’on existe?”(p.23). It is this type of question that gives Laurence the sense of the superficial life she lives: “voilà bien le genre de question que les enfants vous assènent alors que vous ne pensez qu’à vendre des panneaux de bois”(p.23). It is important to note that Laurence works in advertising, a job which embodies the shallow nature of her society. As de Beauvoir describes it: "la publicité… lancent des slogans, des mythes… masquent le monde reel".8 However, Laurence is aware of this, realising the hypocrisy of selling wood panels as "sécurité"(p.23) even though they are liable to go up in flames.

Laurence sees many similarities between Catherine and herself at that age: “Moi aussi, à son âge, je pleurais”(p.25). Recognising the superficial world she lives in and was taught to conform to, she wants to do better for Catherine. This is illustrated when Laurence sees the “charmante fillette”(p.158) dancing in Greece and is horrified to think she is destined to turn into her “placide, bovin”(p.158) mother. This brings to her mind what will happen to Catherine: “qu’on était en train d’assassiner”(p.158). While Jean-Charles is insisting that Catherine sees a psychologist and should be kept away from her friend Brigitte, Laurence believes that this will make her as insensitive as everyone else. Laurence feels she must have her eyes opened to the world, have her friend Brigitte, grow up differently. But even her father, who Laurence believed would support her in this decision, lets her down here. It is this deep-rooted need to protect her daughter that leads to, and forms the basis of her outburst at the end of the book: “je ne permettrai pas qu’on lui fasse ce qu’on m’a fait”(p.180).

4) Disillusionment Regarding her Father (Precipitating)

Laurence initially idolises her father:"Pour un éloge de lui, que ne donnerait-elle pas?"(p.35) - and wants to grow closer to him, endeavoring to discover his key to happiness: "elle se demande quel est son secret et si jamais elle le découvrira."(p.36). Laurence’s father is described as “une passéiste"(p.10) which contrasts to the modern technocratic society around Laurence. However, on their trip to Greece it becomes apparent that he is as artificial as everyone else. He is only interested in historical artefacts and architecture, not the modern town “il n’y a rien à voir”(p.156). His “indifférence”(p.158) towards the young girl that Laurence finds so charming, and description of the  peasants as having “un austère bonheur”(p.165) is also notable. In fact, de Beauvoir uses his reunion with Dominique to highlight that

the two styles of bourgeoisie (modernist and traditional) represented by these characters are equally superficial.8

The disappointment of discovering that her father held no secret is one of the key precipitating factors of Laurence’s breakdown: “[Ce secret] n’existait pas… j’ai été déçue”(p.179) . It is noteworthy that Laurence expresses her emotions through her body rather than verbally, as de Beauvoir describes: "la désillusion de Laurence n’est pas articulée en mots mais elle s’inscrit dans son corps".6 Although we have decided that Laurence does not suffer from an eating disorder, this description fits perfectly with the concept of translation of emotional turmoil into behavioural symptoms of starvation, binge eating or vomiting.9 Events with elements of disappointment and loss are recurring themes in depression, further supporting the argument that her idolisation of Papa and subsequent disillusionment were key factors in Laurence's depression.10

In addition, at this point in the book de Beauvoir refers to the Oedipus complex with Laurence saying: "Je suis tout simplement jalouse. Œdipe mal liquidé, ma mère demeurant ma rivale."(p.179). This is a Freudian psychoanalytical theory linking sexual desire for a parent to neurosis in later life. Some believe that conflict with an internal Oedipus complex results in symptomatic depression in adult-life.11

Social Factors

Setting of Les Belles Images

Les Belles Images is set in Paris during the mid-60s; a time of social, political and moral change. Having spent many years at war, France was enjoying a period of prosperity at the beginning of this decade. There was an exponential increase in technological progress and social welfare, and with this a consumerist society emerged.12 In May of 1968, there were student protests in Paris after the closure of a University campus due to demonstrations over the right to have guests of the opposite sex in their rooms. This reflected the rise of feminism and sexual freedom in France, and a move to end gender inequality.13 Laurence's socio-political environment  could have influenced the development of her mental health, with her conflicting views on current attitudes perpetuating her condition.

1) Consumerism

The consumerist society is apparent from the opening of the book, with a rendezvous of the main characters at Dominique’s country house. This location was an exclusive neighbourhood away from the city, where wealthy Parisians had their weekend homes. The characters display their materialistic priorities with conversation revolving around architecture, foreign travel and technology. De Beauvoir accurately represents the social climate in Paris at the time, stating that she used phrases originating from respected technocratic thinkers: "la plupart des phrases que je mets dans leur bouche ont été cueillies chez les ‘penseurs’ que nos technocrates respectent le plus".6

Those close to Laurence place a lot of importance on material wealth and image, setting them apart from her.  The reason behind Dominique’s need to demonstrate wealth and material possessions may be because she worked so hard to earn it: “elle est arrivée à la force des poignets, en travaillant comme une cheval, en piétinant ceux qui la gênaient”(p.9). For Laurence, however, money is less important, perhaps as she has grown up in a wealthy household. This is conveyed in the car accident where Laurence chooses to avoid the cyclist and, in doing so, damages the car. The materialist views of those around her become obvious to Laurence when Jean-Charles feels that she made the wrong choice: “Je ne trouve vraiment pas ça malin; nous n’avons qu’une assurance tierce-collision”(p.134). This causes her to question their moral values: “Qui choisirait sincèrement de payer huit cent mille francs pour sauver la vie d’un inconnu?”(p.150). She once again find herself isolated from them, asking: “est-ce moi qui suis anormale?”(p.150).

Laurence sees that in the affluence of the rich there will always be consequential poverty. This is a major source of anxiety for her, especially as Catherine begins to reflect these feelings. Her attempts to persuade Catherine, and herself, that others are indeed happy fail, confirming this painful awareness of unhappiness and suffering.

Furthermore, she realises that she and those around her have become indifferent to human suffering by denying its existence. For example, when contemplating the young working girls in the suburbs, she questions the acceptance of these situations, and her level of empathy with them: "encore de ces “incidences humaines” qui sont regrettables. Ai-je raison, ai-je tort de si peu m’en soucier?"(p.80-81).

2) Gender Inequalities

Laurence also struggles with her role as a working wife and mother: "L’amour, la maternité, c’est un choc émotionnel violent" (p.43). The pressure that she feels from Jean-Charles and Dominique to maintain a certain image: “l’image qu’il se fait de nous, petite fille, jeune femme exemplaires”(p.133) could make it difficult for her to express herself. She feels that she has never decided anything for herself: "Jamais je n’ai rien décidé: pas même mon mariage; ni mon métier; ni mon histoire avec Lucien"(p.119), nor formed her own opinion of things instead following those enforced on her, particularly by men. Stereotypic gender roles and male superiority can greatly increase the risk of developing depression in women.5 Dominique’s need for the security of a man: “Une femme sans homme est une femme seule”(p.116), conflicts with the changing attitudes of the time, and this may have been a source of internal dilemma for Laurence.

3) Support Systems

A crucial protective factor for those with mental health problems is the support they receive from those around them.14 In Laurence’s case: “Dominique, puis Jean-Charles l’ont bien étouffée. Mona lui reproche son indifférence, et Lucien de n’avoir pas de coeur”(p.134). This may be a key factor in her persistent problems and recurrent depressive episodes.

Dominique tends to rely on Laurence, but does not offer much support in return. After being spurned by Gilbert, Dominique demands her full attention, but the discomfort that Laurence experiences is never discussed: "dès l’enfance [Laurence a] appris à maîtriser [son] cœur"(p.64). This restriction of expressing her feelings is likely to have prevented Laurence from looking to her mother for advice or consolation.

As her spouse, Jean-Charles is expected to play a key role in supporting Laurence’s recovery. Instead, in an effort to maintain the appearance of a perfect marriage, Laurence avoids confrontation with Jean-Charles, who uses gestures of material gifts to keep the peace between them: “parfaite image du couple qui s’adore encore après dix ans de mariage. Il achète la paix conjugale, les joies du foyer, l’entente, l’amour; et la fierté de soi”(p.141). This reinforces the attitude that true happiness is not important if the illusion of it is maintained, and her inability to freely discuss how she feels could be a perpetuating factor in her condition. Jean-Charles also refuses to acknowledge the severity of her mental health issues. Laurence sees it as a betrayal of trust when he downplays her depressive episode of five years before,

exclaiming: “Ah! Ne recommence pas à me faire une crise de mauvaise conscience comme en 62”(p.133). This would make it difficult for her to turn to him for help.

As well as the lack of support from her family, Laurence mentions on more than one occasion a lack of close friends: “c’est précieux une amitié. Si j’avais une amie, je lui parlerais au lieu de rester prostrée”(p.172). It seems obvious that she feels entrapped.  Research has shown that this lack of close friendships has strong links to psychiatric conditions.15

Protective Factors

In Laurence’s case, several protective factors were identified: she loves her children, she

works, has financial stability and independence, and lives in a good neighbourhood. In the

interest of determining the causes of her illness, these will not be described in detail, but

have been included in the formulation table in the Appendix.

Summary of Causes

In exploring Laurence’s character it is clear that there are numerous causes for her mental state. It is not possible in this project for us to look at them all in sufficient depth, and thus we have focused on a handful that we believe are important.

It is likely that her oppressed upbringing  predisposed Laurence to mental illness, perpetuated by the pressure to conform to the image projected by the society that she is confined in. The disillusionment of her father and Catherine’s existential questioning precipitate Laurence’s eventual breakdown as it becomes clear to Laurence that she is trapped in this “monde de mensonge”.8 While searching for the truth, Laurence realises that she is merely opening her eyes in the dark.8 In an interview Simone de Beauvoir discusses this breakdown, saying that she initially had it culminate in tears rather than vomiting, but this wasn’t enough: “elle est vraiment piégée par la monde où elle vit : j’ai supprimé les larmes".8

Conclusion

Diagnosis

We came to the conclusion that Laurence most likely suffered from chronic dysthymia, with intermittent depressive episodes and panic disorder–a form of

anxiety. We objectively filled in medical scoring systems to support our diagnoses and strengthened our arguments using existing reviews of the book.

Furthermore, it is very difficult to take a patient history from a fictional character. Reader interpretation was a source of bias; for example some reviews came to different conclusions,  and translation may have led to changes in meaning of certain parts of the text. This was particularly apparent in the eating disorders section, perhaps due to the changing nature of diagnostic criteria throughout history.

Causes

Our work in this section made it apparent that a combination of various causes contributed to the development of Laurence’s mental state. We were unable to investigate all possible factors, and this was our predominant limitation. In addition much of this section was subject to the interpretation of the reader, and although we have tried to be objective, there is always potential for investigation bias.

Personal Reflections

On completion of this project, we have achieved our objectives:

In analysing Les Belles Images, we fulfilled our objective to 'view and understand mental health from a new perspective'. We feel that our empathy for patients experiencing mental health problems has greatly increased and we have realized that mental health problems develop from a complex interplay of factors that are unique to the individual.

We feel our skills in literary technique and analysis have grown. The project has required us to look at other reviews of the book with a critical eye, compare and contrast our work with that of others, while exploring a wide range of themes that surround the novel.   We all agree that our knowledge base in this area has significantly increased.

Finally, by reading the book in both languages, we have improved our French language skills.

Synopsis

A Parisian garden party opens the book. Laurence, the protagonist, works in advertising and is married to Jean-Charles, a wealthy architect.They have two daughters, Catherine and Louise. Catherine, the eldest, has begun asking questions about unhappiness in the world, and sometimes cries at night.  Laurence lies to reassure her, but fears her daughter will become like her. Despite appearing to have all she needs, and an affair with a man named Lucien, Laurence longs for a deeper happiness.

Laurence’s sister Marthe is a devout convert to Christianity, of which Laurence is sceptical. Their divorced parents are polar opposites. Dominique, their mother, is a determined woman, whose partner Gilbert is one of the wealthiest men in France. Gilbert has an estranged wife, Marie-Claire, who refuses him a divorce, and an ex-mistress, Lucile. Laurence’s relationship with her mother is fragile.

Her father,  ‘Papa’, is an intellectual recluse; a parliamentary draftsman. Dominique left him on realizing that he would never share her ruthless drive for success. Laurence admires her father's unique lack of materialism.

In the second chapter, Gilbert confides in Laurence about his affair with Patricia, the young daughter of his ex-mistress. He intends to marry her. Laurence visits her mother the next day to find Gilbert has revealed his infidelity, but not of the identity of his new lover. Dominique is concerned what others will think of her, but insists she will win Gilbert back.

Laurence meets Catherine’s new friend Brigitte. She is a year older and less shielded from the world and media. Laurence likes Brigitte but is unsure whether she is a good influence on Catherine. She tries to find out if Brigitte has been telling Catherine about things that might upset her, such as child poverty and starvation, and asks she be careful what they discuss.

A snapshot of Laurence’s relationship with Lucien as they spend an evening together ends in the usual argument about why she cannot stay. Laurence contemplates her relationship with Jean-Charles and why she has chosen him over Lucien. Marthe arrives unannounced to ask about Catherine receiving first communion, which Laurence finds intrusive.

At evening rendezvous at Dominique’s country residence, Dominique confides her suspicions to Laurence that Gilbert is in love with his ex-mistress. She continues to

insist she will be able to keep him, and believes the two of them will spend Christmas together. Gilbert later takes Laurence aside and dismisses the notion.

Laurence and Jean-Charles make love that night, and Laurence experiences one of her rare moments of true pleasure. Driving home, she swerves to avoid a cyclist, destroying their car. Jean-Charles is angry and shows more concern for his vehicle than his wife.

Inspired by her father’s apparent happiness with simplicity, Laurence decides to ‘unclutter’ and resolves to stop seeing Lucien. She ends their relationship at a luxury nightclub.

Dominique is told of Gilbert’s relationship with Patricia and suffers a breakdown. Gilbert's wife, Marie-Claire, finally agrees to a divorce. In her fury, Dominique voices an intent to write to Patricia, revealing her mother Lucile’s ‘whoring with Gilbert’ as revenge for his disloyalty.

Laurence consoles Dominique and persuades her to go to bed with a sleeping pill, but finds out later that she sent the letter regardless. Laurence panics and spontaneously vomits.

Gilbert calls Laurence, telling her to go see her mother immediately. On arrival there are signs of turmoil and Dominique is visibly distressed. It transpires that Patricia showed Gilbert the letter and he retaliated, assaulting Dominique. Laurence talks her mother out of suicide, which she describes as her “only option”. Despite feeling sympathetic, Laurence cannot help but be slightly repulsed by her mother. She takes her for lunch and advises a fresh start.

On seeing his daughters’ school reports, Jean-Charles is furious as Catherine’s grades have slipped. He scolds her and  blames Brigitte, citing her older age and Jewish heritage. When Laurence defends Catherine, he accuses her of being overly dramatic - comparing the situation to her breakdown five years previously. He later sends flowers to apologise and buys her an extravagant necklace. To her, these are empty gestures to maintain an illusion of une belle image.

Laurence lies to Jean-Charles about having eaten. They celebrate New Year at Marthe's. Dominique is there, but has trouble speaking and maintaining a smile from taking excessive tranquilisers. She and Papa seem closer than usual. Papa

approaches Laurence and asks if she would like to take a trip to Greece with him. She agrees with delight.

In the final chapter, Laurence has fallen ill.  She has not been eating and  anorexia is mentioned. From her bed, she recalls the trip to Greece. She relives the joy of discovering language through her father, as he deciphers the lettering on buildings for her. As the holiday progresses she becomes disinterested and wonders why she cannot experience true enthusiasm in the way others seem to. Her distress grows on seeing the impoverished parts of the area. By the end she is bored and disappointed. Having hoped to unlock her father’s secrets to contentment and build their relationship, she has discovered that he is not as infallible as she had thought. He seems indifferent to Catherine’s seeing of a psychologist, which they discuss when Laurence is reminded of her daughter by a young girl dancing.

Upon her return, Laurence learns that the psychologist has recommended that Catherine stops seeing Brigitte, and that her parents have resumed their relationship. She does not take well to either piece of news, feeling her father is being hypocritical, having always criticised Dominique.

She later claims to feel forced into agreeing with the views of others, stating that everyone is against her. Eventually she is almost reduced to hysteria, feeling deceived and manipulated by the painted image of happiness she has been sold all her life. She shouts and fights with Jean-Charles relentlessly. In the end she takes the fatalistic view that for her, it is too late, but she will not be pressured into raising Catherine as ‘une belle image’.

Prime MD Patient Health Questionnaire (PMQ) – Laurence

The following questionnaire and mark scheme were sourced from:

Ohio Association of County Boards. Quick Guide to PRIME-MD Patient Health Questionnaire (PHQ).  [Online] Available from: http://www.oacbdd.org/clientuploads/Docs/2010/Spring%20Handouts/Session%20220j.pdf [Accessed 14th February].

The accompanying mark scheme can be found here.

Hard Copies of Questionnaire

Questionnaire p1 - Mood Disorders

Questionnaire p2 - Anxiety Disorders

Questionnaire p3 - Eating Disorders

PHQ 9 - Depression Severity

GAD 7 - Anxiety

GAD 7 (Anxiety) & PHQ 4

PHQ 15 - Somatic Symptoms

Results

Page 1   of Questionnaire   - Mood   Disorders  

The first page of the questionnaire pertains to the likelihood of a diagnosis of the following three conditions:

- Somatoform Disorder

- Major Depressive Syndrome

- Other Depressive Syndrome

"The diagnosis of Major Depressive Disorder and Other Depressive Disorder requires ruling our normal bereavement (mild symptoms, duration <2 months), a history of a manic episode (bipolar disorder) and a physical disorder, medication or other drugs as the biological cause of the depressive symptoms." In Laurence's case, we see  no evidence of the above, thus any probably diagnoses found below would be classed as disorders, not syndromes. 

Somatoform Disorder criteria: "Somatoform Disorder if at least 3 of Q1a-m bother the patient "a lot" and lack an adequate biological explanation."

Laurence:

Not Bothered: IV

Bothered a little: II

Bothered a lot: VI

Result: POSITIVE

Major Depressive Syndrome criteria: "Major Depressive Syndrome if Q2 a or b and five or more of Q2a-i are at least "more than half the days" (count Q2i if present at all)."

Laurence:

Q2a: Nearly every day

Q2b: Nearly every day

Q2i: Not at all

Others:

Not at all: I

Several days: IV

More than half the days: 0

Nearly every day: II

Result: NEGATIVE

Other Depressive Syndrome criteria: "Other Depressive Syndrome if Q2a or b and two, three or four of Q2a-i at at least "more than half the days" (count Q2i if present at all)."

Laurence:

Q2a: Nearly every day

Q2b: Nearly every day

Q2i: Not at all Others:

Not at all: I

Several days: IV

More than half the days: 0

Nearly every day: II

Result: POSITIVE

 Page 2 of Questionnaire -   Anxiety Disorders

– Panic Syndrome

– Other Anxiety Syndrome

The diagnosis of Panic Disorder and Other Anxiety Disorder require ruling out of a physical disorder, medication or other drugs as the biological cause of the anxiety symptoms.  In Laurence's case there is no evidence of any of these thus we class any probable diagnoses below as disorders, not syndromes.

Panic Syndrome criteria: "Panic Syndrome if Q3a-d are all "YES" and four or more of Q4a-k are YES"

Laurence:

Q3a-d: All "YES"

Others:

YES: IX

NO: II

Result: POSITIVE

Other Anxiety Syndrome criteria: "Other Anxiety Syndrome if Q5a and answers to three or more of Q5b-g are "more than half the days".

Laurence:

Q5a: More than half the days

Others:

Not at all: II

Several days: III

More than half the days: I

Result: NEGATIVE

Page 3 of Questionnaire   - Eating Disorders

– Bulimia Nervosa

– Binge Eating Disorder

– Alcohol Abuse

Bulimia Nervosa criteria: "Bulimia nervosa if Q6a, b and c and Q8 are "YES"."

Laurence:

Q6a: YES

Q6b: NO

Result: NEGATIVE

Binge Eating Disorder criteria: "Binge eating disorder is the same as above but Q8 is either "NO" or left blank.

Laurence:

Q6a: YES

Q6b: NO

Result: NEGATIVE

Alcohol Abuse criteria: "Alcohol Abuse if any of Q10a-e are "YES"."

Laurence:

YES: 0

NO: V

Result: NEGATIVE

 

Additional Tests for More Detailed Results:  

PHQ-9 Depression Severity

Laurence:

Not at all: I (0 points)

Several days: IV (4 points)

More than half the days: I (2 points)

Nearly every day: III (9 points)

Total: 9 + 2 + 4 + 0 = 15/27 points

5 = Mild

10 = Moderate 1

5 = Moderately Severe

20 = Severe

Result: MODERATELY SEVERE

GAD-7 Anxiety Severity

Laurence:

Not at all: I (0 points)

Several days: I (1 point)

More than half the days: 0 (0 points)

Nearly every day: V (15 points)

Total: 15 + 0 + 1 + 0 = 16/21 points

5 = Mild

10 = Moderate `

15 = Severe

Result: SEVERE

"Though designed primarily as a screening and severity measure for generalised anxiety disorder, the GAD-7 also has moderately good operating characteristics for three other common anxiety disorders: panic disorder, social anxiety disorder an post-traumatic stress disorder. When screening for individual or any anxiety disorder, a recommended cutpoint for further evaluation is a score of 10 or greater."

PHQ-2 and GAD-2 Severity

Laurence:

PHQ-2:

Q1: Nearly every day: III

Q2: Nearly every day: III

Total = 6/6

>3 = screen

Result: SCREEN

GAD-2:

Q1: Nearly every day:III

Q2: Nearly every day: III

Total = 6/6

>3 =  screen

Result: SCREEN

PHQ-4 DA PHQ-2 + GAD-2 = 6 + 6 = 12/12

"The higher the score, the more likely there is an underlying depressive or anxiety disorder."

PHQ-15 Somatic Symptom Severity

Laurence:

Not bothered at all: V (0 points)

Bothered a little: III (3 points)

Bothered a lot: VII (14 points)

Total: 14 + 3 + 0 = 17/30 points

5 = Low

10 = Medium

15 = High

Result: HIGH

PHQ-9 Recommended Treatment

Laurence: 15

15-19: "Immediate initiation of pharmacotherapy and/or psychotherapy."

 Psychiatric Formulation

Psychiatric-Formulation

Quote Translations – Les Belles Images

English translations from ‘Les Belles Images’ are by Patrick O’Brien (see references) 

English translations from the Simone de Beauvoir interview are by Joanna Moffatt.

Diagnosis:

Mood Disorders:

“Je suis cyclique”(p.8)                                                                                                   “I am a manic depressive” (p.8)

“dans les veines…une coulée brûlant”  (p.101)                                                     “a molten flood... through (Laurence’s) veins”(p.85)

“aigres déchirements, une certaine irritation, une certaine désolation, du désarroi, du vide, de l’ennui” (p.36)”

“a piercing anguish...a certain wretchedness of mind, folornnes, perturbation, emptiness, boredom...”(p.31)

“chavire de désir”(p.101)                                                                                    “staggered with desire”(p.85)

“explosion de joie”(p.153)                                                                                  “outburst of delight” (p.129)

“Faudra-t-il qu’elle devienne une femme comme moi?” (p.122)                      “Must she turn into a woman like me?” (p.102)

“qu’ont-ils que je n’ai pas?” (p.14, p.19)                                                                “what have they got that I haven’t?”(p13, p17)

“Pourquoi suis-je incapable d’aimer des choses que je sais dignes d’amour?” (p.168)                                                                                            “ Why not me? Why am I incapable of loving things I know to be worthy of love?” (p141-142)

“J’ai l’impression d’être distraite en général” (p.37)                                                “I have the feeling that I’m absent-minded in general” (p.32)

“un gouffre d’indifférence” (p.167)                                                                      “a pit of indifference” (p141)

“la littérature ne me dit plus rien” (p.43)                                                          “Books don’t say anything to me anymore” (p.37)

“cercle vicieux” (p.43)                                                                                        “a vicious circle”(p.37)

“il me semblait n’avoir plus d’avenir…je me négligeais, je m’ennuyais et je me sentais de plus en plus dépossédée de moi” (p.43)                                       "It seemed to me that I had no future anymore...I let myself go, I grew bored, and I felt myself less and less a creature in my own personal possession.” (p.37)

“ce creux, ce vide, qui glace le sang, qui est pire que la mort bien qu’on le préfère à la mort tant qu’on ne se tue pas” (p.85)                                                     “...that emptiness, that void which freezes your heart and which is worse than death although you are preferring it to death so long as you do not kill yourself.”(p.72)

“Je n’en peux plus!” (p.168)                                                                              “I can’t go on” (p.141)

 “une grande fatigue…dans le corps et dans l’âme” (p.167)                            “a great weariness...both bodily and spiritual”(p.140)

“je recontrais la beauté, et je ne trouvais rien à en faire” (p.161)                   “I had come face to face with beauty, and I had not known what to do with it” (p.135)

“elle s’abandonne à la nuit”(p.169)                                                                    “she gave herself up to the darkness”(p.142)

  Eating disorders:

“anorexie” (p.169)                                                                                              “anorexia” (p.142)

“en sueur soudain, elle a envie de vomir”(p.48)                                                  “Suddenly she was sweating and she felt like being sick” (p.41)

“un spasme lui déchire l’estomac, elle vomit tout le thé qu’elle vient d’absorber”(p.121)                                                                                            “a spasm wrenched her stomach and she vomited all the tea she had just drunk” (p.101)

“une peur panique”(p.121)                                                                                  “wildly, irrationally afraid”(p.102)

“Deux jours qu’elle n’a pas mangé. Et après? Puisqu’elle n’a pas faim… Elle a vidé la tasse, et son cœur se met à battre, elle se couvre de sueur. Juste le temps de se précipiter à la salle de bains et de vomir; comme avant-hier et le jour d’avant. Quel soulagement! Elle voudrait se vider plus entièrement encore, se vomir tout entière“ (p.168-9)

“She had not eaten for two days. What of it, since she was not hungry? Their anxious looks. She finished the cup; her heart began to beat and she came out in a sweat all over. Just time to get to the bathroom to be sick, like the day before yesterday and the day before that. What a relief! She would have liked to empty herself even more completely, vomit her whole being right out”(p.142)

 “a parlé d’anorexie” (p.169)                                                                            “talked about anorexia” (p.142)

  “je mangeais avec appétit et indifférence”(p.156)                                                “I ate heartily and without caring at all” (p.152)

“ces taxis grecs ont d’étranges couleurs de sorbet au cassis, de glace au citron” (p.155)                                                                                                  “those Greek taxis have strange colours: blackcurrant water ice; lemon ice-cream” (p.130)

“[Le bonheur] m’enveloppait tandis que nous mangions du mouton grillé” (p.155)      “(Happiness) enfolded me as we sat there eating grilled mutton” (p.131)

Anxiety:

“d’une trentaine d’années” (from interview)                                                            “30 years old”

“les barbituriques” (p.52)                                                                                    “barbiturates” (p.44)

“demander quelque chose à sa mère l’intimide autant que lorsqu’elle avait quinze ans” (p.14)                                                                                                      “asking her mother for something made her feel as nervous now as it had done when she was fifteen.” (p.13)

“Anxiété, remords. Les humeurs quotidiennes…toutes ces contingences qui devraient s’effacer derrière moi, ça s’inscrit dans cette enfant” (p.135) “Anxiety, remorse. Everyday little fits of temper...all these fortuitous trifles that ought to vanish behind me are written deep in the mind of this child” (p.114)

“avant de se mettre au lit elle prend un cachet.” (p.120)                                      “...took a pill before getting into bed” (p.101)

“Mais ce noeud dans ma gorge m’empêche de manger” (p.153).                      “But this lump in my throat stops me eating” (p.129)

“L’horreur prend Laurence à la gorge… Ah! Toutes les images ont volé en éclats, et il ne sera jamais possible de les raccommoder.” (p.124). “Horror seized Laurence by the throat...Oh, all the pictures had been shattered to pieces, and it would never be possible to put them together again”(p.104)

Causes:

Biological factors:

“qui imite-t-elle?” (p.34)                                                                                      “Who is she copying”(p.29)

“derrière les images…qui se cache? Peut-être personne du tout.” (p.17) “Who was hiding behind those reflections? Maybe nobody at all.” (p.15)

“je n’ai plus qu’à mourir”(p.124)                                                                        “There’s nothing left but to die” (p.104)

Psychological factors:

“c’est mon père que j’aimais et ma mère qui m’a faite”(p.33)                             “It was my father I loved and my mother who formed me,” (p.29)

“Elle a toujours été une image. Dominique y a veillé” (p.21)                              “She had always been a picture. Dominique had seen to that” (p.19)

“elle”= “she”                                                                                                                   “je” = “I”

“Marthe a eu une amie… Moi non. Jamais.”(p.55)                                                “Marthe had a friend...Not me. Ever” (p.47)

“une étrangère”(p.17)                                                                                        “a stranger”(p.15)

“demander quelque chose à sa mère l’intimide autant que lorsqu’elle avait quinze ans.” (p.14)                                                                                               “...asking her mother for something made her feel as nervous now as it had done when she was fifteen.” (p.13)

  “il s’agissait de faire parler le silence” (interview)                                             "it was done through silence"

“[elle] a du chagrin, la nuit elle pleure” (p.8)                                                  “[She] was sad about something, she cries in the night” (p.8)

“pourquoi est-ce qu’on existe?”(p.23)                                                                “Why do people live?” (p.20)

“voilà bien le genre de question que les enfants vous assènent alors que vous ne pensez qu’à vendre des panneaux de bois” (p.23)                                   “That is exactly the sort of question children stun you with when all you are trying to do is to sell wooden panelling.”(p.20)

“la publicité… lancent des slogans, des mythes… masquent le monde reel” (from interview)                                                                                                      "advertisments...casting out slogans, myths...hide them from the real world" 

“sécurité” (p.23)                                                                                                “security” (p.20)

“Moi aussi, à son âge, je pleurais”(p.25)                                                              “I cried too, at her age” (p.22)

“charmante fillette”(p.158)                                                                                  “charming little girl”(p.133)

“placide, bovin”(p.158)                                                                                      “calm, fat” (p.133)

“qu’on était en train d’assassiner”(p.158)                                                    “whom they were murdering at that moment” (p.133)

“je ne permettrai pas qu’on lui fasse ce qu’on m’a fait” (p.180)                           “I shan’t let what had been done to me be done to her.” (p.152)

”Pour un éloge de lui, que ne donnerait-elle pas?” (p.35)                                      “What was there she would not give for praise from him?” (p.30)

“elle se demande quel est son secret et si jamais elle le découvrira.” (p.36) “She wondered where his secret lay and whether she would ever be able to discover it” (p.31)

“une passéiste”(p.10)                                                                                      “a good-old-days creature” (p.10)

“il n’y a rien à voir”(p.156)                                                                                “There’s nothing to be seen there” (p.131)

“indifférence” (p.158)                                                                                           “unmoved” (p.133)

“un austère bonheur”(p.165)                                                                                “An austere happiness” (p.139)

“[Ce secret] n’existait pas… j’ai été déçue”(p.179)                                                “[The secret] did not exist...I’ve been deceived”(p.151)

“la désillusion de Laurence n’est pas articulée en mots mais elle s’inscrit dans son corps” – interview

 “Je suis tout simplement jalouse. Œdipe mal liquidé, ma mère demeurant ma rivale.” (p.179)                                                                                                  “I am just plainly jealous. Oedipus not coped with properly, my mother still my rival”(p.150)

Social factors:

“la plupart des phrases que je mets dans leur bouche ont été cueillies chez les ‘penseurs’que nos technocrates respectent le plus” (from interview)                        "most of the phrases I put in their mouth were taken from the ‘thinkers’ that the technocrats most respected."

“elle est arrivée à  la force des poignets, en travaillant comme une cheval, en piétinant ceux qui la gênaient” (p.9)                                                                      “She had succeeded by the sweat of her brow, working like a black and trampling over anyone who stood in her way” (p.8)

“Je ne trouve vraiment pas ça malin; nous n’avons qu’une assurance tierce-collision”(p.134)                                                                                                “It really doesn’t seem very clever to me; we only have a third-party collision insurance” (p .113)

“Qui choisirait sincèrement de payer huit cent mille francs pour sauver la vie d’un inconnu?”(p.150)                                                                                              “Which of them would honestly choose to pay eight thousand francs to save the life on an unknown?” (p.126)

“est-ce moi qui suis anormale?” (p.150)                                                                “Am I the one who is abnormal?” (p.126)

“encore de ces “incidences humaines” qui sont regrettables. Ai-je raison, ai-je tort de si peu m’en soucier?” (p.80-81)                                                     “Another of those regrettable ‘human effects’. Am I right or am I wrong to mind it so little?”(p.68)

“L’amour, la maternité, c’est un choc émotionnel violent” (p.43)                     “Love and motherhood constitute an emotional shock” (p.37)

“l’image qu’il se fait de nous, petite fille, jeune femme exemplaires” (p.133)              “The picture he has made of us, the exemplary little daughter and the exemplary young wife” (p.112)

“Jamais je n’ai rien décidé: pas même mon mariage; ni mon métier; ni mon histoire avec Lucien” (p.119)                                                                                 “I have never decided anything; not even my marriage, nor my profession, nor affair with Lucien” (p.100)

“Une femme sans homme est une femme seule” (p.116)                                    “A woman without a man is a woman entirely alone” (p.97)

“Dominique, puis Jean-Charles l’ont bien étouffée. Mona lui reproche son indifférence, et Lucien de n’avoir pas de coeur” (p.134)             “Dominique and then Jean-Charles had thoroughly smothered that. Mona blamed her for her indifference and Lucien for having no heart.” (p.112)

“dès l’enfance [Laurence a] appris àmaîtriser [son] cœur” (p.64)          “When I was a child [Laurence] learned to control [her] heart.” (p.54)

“parfaite image du couple qui s’adore encore après dix ans de mariage. Il achète la paix conjugale, les joies du foyer, l’entente, l’amour; et la fierté de soi” (p.141)          “a perfect picture of the couple who still adore one antoher after ten years of marriage.” (p.118)

“Ah! Ne recommence pas à me faire une crise de mauvaise conscience comme en 62” (p.133)                                                                                                      “Oh, don’t start another guilty-conscience scene, like the one you treated me to in ‘62” (p.112)

“c’est précieux une amitié. Si j’avais une amie, je lui parlerais au lieu de rester prostrée” (p.172)                                                                                              “If I had a friend I should talk to her instead of lying here spiritually exhausted.” (p.145)

Summary of causes:

“monde de mensonge” (from interview)                                                                “The world of lies”

  “elle est vraiment piégée par la monde où elle vit  : j’ai supprimé les larmes.” (from interview)                                                                                                    “she is really trapped in this world where she lives: I removed the tears.”

Weekly Diary

12/01/2015

Met with Dr Yeoman (tutor) Discussed a synopsis of the book, Les Belles Images Extrapolated the main themes of the book and discussed which ones to pursue in

our project Organised a meeting for the following Friday and Monday (the latter with Dr

Yeoman)

16/01/2015

We further discussed our thoughts on the book and brainstormed potential areas to study, such as feminism and gender roles, mental health, the role of society, culture and class and the changes in mentality over the three generations of women.

We concluded that including a strong medical angle in our project would be intersting, and that we were aiming for depth of analysis rather than breadth, so we would focus mainly on only Laurence.

We decided to each think of a suitable project title by our next meeting, which we arranged for 19/01/15.

19/01/2015

Discussion: We met up with our tutor Dr Yeoman and discussed what we thought of the book; the different characters and themes within the novel. We looked at various quotes within the book that were profound to each of us and what they meant in the wider context of the book.

Put forward ideas for our project and how we would divide the project into different sections, coming up with an overall structure for the website.

Introduction; synopsis; Laurence/diagnosis/quotes; causes of her condition; today’s comparison; conclusion

“What would we diagnose someone like Laurence with? In the here now culture of today.”

Aimed to know when the deadlines for the project are. Discussed the different causes for Laurence’s condition, with a particular

emphasis on gender roles. Put forward ideas for the title of our project. We were keen on Ailsa’s title: ‘The

ugly side of “Les Belles Images”: depression, oppression and the bourgeoisie.’ Delegated different tasks to do for the following week:

Read through the book and highlight references to Laurence’s condition, giving each person a chapter

Build a synopsis of the book Chapters

1: Tim 2: Joanna 3: Ailsa, Rufus 4: Zoey

Decided on organizing a meeting to set up with Lucy. This would give us a good understanding of mental health conditions, and to see how she produced her website.

Plan on reading an interview with Simone de Beauvoir. This would give us an insight into her aims behind writing the book and what it means to her.

Next meeting - Monday 26/01/2015, 5pm at Victor Hugo, with Dr Yeoman

26/01/2015

Admin : First we filled out and signed the ethical assessment form – deadline 30/1/15 (Friday), now it just needs Dr Yeoman’s signature before it can be handed in.

We identified the project deadline - MARCH 20TH

 

Quotes – Having highlighted a huge number of interesting phrases and quotes from throughout the book we talked about some of the most important/relevant ones and decided that Tim, Ailsa and Joanna will categorise them (meeting Wednesday after lectures at the library to do this).

Discussion: Synopsis – we talked through each of our chapter synopses and realized that it is already very long so set ourselves a word limit of 800 words. Zoe and Rufus will put the individual chapter synopses together and to make a concise summary of the book by Friday. We also considered making a separate family tree or character list.

Work to do this week: Put together a single synopsis Categorise our selected quotes Look into setting up the website

Next meeting  30/1/15 Friday lunchtime (1.15pm) at Teviot With Dr Yeoman - next Monday 2/2/15 at 5pm?

30/01/2015

‘Midweek’ meeting at Teviot. Overview of week’s progress so far. Assigned roles: Rufus, Ailsa and Joanna to research clinical features of

depression, anxiety and anorexia respectively. Tim and Zoe to write an introduction.

Agreed to complete work for Monday. Rufus and Zoe to continue editing the synopsis. Arranged meeting with Dr Yeoman for Monday at Doctors pub. General feedback so far and literary discussion.

02/02/2015

Forwarded all work to Dr Yeoman. Clarified our aims and objectives with the group. Debated the structure of the project, and agreed on a way to move forward. Overview of work so far and set objectives for next week. A draft of the first section to be completed by Rufus, Ailsa and Joanna on

‘diagnosis’ – to tie quotes together with medical research to assess the nature of Laurence’s illness.

Zoe and Tim to start their section on the causes of Laurence’s condition, researching medical literature and relating this to the text.

Agreement to meet again on Monday as usual.

06/02/2015

So far: Tim and Zoe have begun to look into the “Causes” section of the project Tim has focussed mainly on the themes: the value of money, social status and

Laurence’s relationship with Dominique. He has also identified a potential Oedipus’ complex in Laurence concerning Papa.  A quotation directly addressing this was also noted:

“That evening she had thrown up her dinner: she stayed in bed the next day, and the next, overwhelmed by a chaotic sequence of pictures and words that raced through her head, fighting among themselves like Malay krisses in a closed drawer (if you open it, everything is in order). She opened the drawer. I am just plainly jealous. Oedipus not coped with properly, my mother still my rival.” P150

Zoe and Tim have identified the following areas to look further into: Laurence and Jean-Charles’ love/sex life, Laurence’s affair with Lucien, gender roles and Laurence’s career.

Rufus is continuing with his research into depression and is writing this part of the “Diagnosis” section.

Joanna has been looking into the eating disorder part of the “Diagnosis” section. We discussed how best to write this because the fact that we don’t believe Laurence suffers from them is making this tricky. We came to the conclusion that it might be best if we married this part with the part on anxiety and use the contrasting diagnoses to illustrate the relevance of the symptoms to our choice. This will also help to avoid repetition and conserve words.

Ailsa has begun to write her part of the “Diagnosis” section of anxiety. She has identified a possible diagnosis of panic disorder, and has written as such. She has also found a written test for this and filled it out as if she were Laurence - which could be an interesting addition to the project.

A meeting has been set up with Dr Stirling to review our progress and work on the 16th of February.

 

For next Monday: Finish drafts of sections Email Dr Yeoman (Jane) the copies of what we have by Saturday night/Sunday

morning Continue to research themes (Tim and Zoe) Complete half-way feedback for SSC2b on EEMEC

17/02/15

Meeting with Dr Stirland 

We discussed what we’ve chosen to do in the project; explaining the different sections of the project

Dr Stirland gave us some valuable information for the mental health diagnosis section of the project She explained some key risk factors for mental health conditions ie family

history We investigated what depression actually:

The types of depression What criteria is needed

We looked at how depression is diagnosed and what methods GPs and psychiatrists use to guide their diagnosis, and the problems with these methods GP health questionnaires (ie PHQ9) Holmes-Raye

We talked about the cause of depression and what treatment is used, and how patients respond to treatment ie anti-depressants

We talked about the various other disorders that Laurence could be suffering from, or that of her mother ie personality disorders and the criteria for such conditions. This involved discussing further theories such as “attachment theory” and

“psychodynamic theory” In addition to personality disorders, we looked at different mood disorders such

as cyclothymia and dysthymia. We looked at the importance of the culture that Les Belles Images was written

in: mid 1960s, when current medication for mental health disorders was not available

Overall we linked these findings with our character Laurence, trying to find the correct health condition that she falls into

We considered the spectrum of mental problems across the generations of characters in the novel; Dominque to Laurence to Catherine.

Dr Stirland kindly recommended some books and useful resources for us to consider Oxford handbook of psychiatry Crash course psychiatry

ICD10

Aims:

To look at the information Dr Stirland has recommended To continue in writing our allocated sections of the project, while incorportating the

advice Dr Stirland has given us We have set a deadline for Friday to have a draft of each of our sections to send

to both Dr Stirland and Dr Yeoman To organize a next meeting with both Dr Stirland and Dr Yeoman together.

25/02/15 Meeting with Dr Yeoman

Aims:Go over what each member of the group has done with regards to each sectionDiscuss any difficulties or questions we have come acrossListen current feedback from JanePlan next steps

We briefly summarized where we each were in our allocated sections of the project and listened to one another's ideas and feedback. Jane liked the style of the "diagnosis" section, but felt that the "causes" might be better with more structure and a less creative writing approach. We discussed this as a group and concluded that we liked the creative and poetic style, but that signposting each section more clearly with book-specific titles would allow for greater clarity.

We also decided that, should word limits allow, we would like to include more detail in the introduction.

The quotes from the books were discussed, and whether they ought to be in english as well as french. For the moment we concluded that it would be best to have the french only, and rely on the rest of our work to provide a context which would allow the reader to understand roughly what the quote said. Should there be enough words left, we could potentially add an English translation in later on.

With the tight word count in mind, we tried to think of a solution to our long synopsis. It could be incorporated into the "causes", however this posed problems as there would then be little context for the "diagnosis" section, and the "causes" would require significant re-writing and might become confusing. Instead we opted to

create a basic timeline of events in the book, which we could then build on as necessary to explain particular areas of the book to which we refer.

Finally we touched on the content of our conclusion, and decided that it should contain a brief summary of each section, followed by a larger reflective element. The reflection is to include topics such as the difficulties we faced, what we did and didn't enjoy and what we got out of the project. Some detail on all of the additional things we did, such as reading many other papers, lectures, reviews, learning about french language and culture, and attending a variety of relevant events, would also fit nicely.

Tasks:

Edit and clarify each of our OWN sections, add a word count and upload to facebook (by 12pm Saturday)Add more specific titles in to the "causes" section to act as signposts (by 12pm Saturday)Ailsa: email these to Jane and LucyCritically read ALL of each other's work, noting down any comments we have. Bring this to the next meeting. (by Monday 1pm meeting)Create a basic timeline (Rufus)

Next meeting: Monday 2nd March, 1pm.

Aims:begin forming groups and switching our work around to editdecide on where words need to be cut from and create a provisional word limit for each sectionfeedback on each other's work, discussing the comments we have each made and answering any queries

02/03/2015

Discussion

Read through and discusses each other’s sections Critically appraised each other’s work

Made list of things to correct for uploading a final draft of each section, for before Wednesday’s meeting.

Tasks

Amend each section, with the advice given (minor changes): Rufus; depression, Ailsa and Joanna; anxiety and anorexia, Tim; references for

medical evidence of causes (use for info search report), Zoe; minor changes to causes and introduction.

Upload final version of each section to website with changes done for meeting on Wednesday Upload by Tuesday 9:00 am to facebook group, to be uploaded by Ailsa onto

the website Email by 9:00 am each section to Dr Yeoman and Dr Stirland

After Wednesday editing swap: Joanna and Ailsa to take on causes (medical evidence incorporation) Rufus by Sunday to take on medical diagnosis (marry up sections to flow with

similar structure) Tim to take on conclusion Zoe to take on synopsis (cut down)

Deadlines

11 days until last week (website organization, conclusion, contributions, information search report, SSC2b hand report, appendix) 12 th March.

18 days until final deadline on submission. 20th March

Next meeting

Wednesday 4th March, 5:30pm, Teviot Library Bar. Dr Yeoman and Dr Stirland

04/03/2015

Points for causes section:

Subheadings for categories

List of subheading in introduction for clarity

Laurence’s internalisation of Dominique’s views – quote: when thinking of Slogan in beginning of book

Reference to language quote: Greece with Father, mother that formed her, father that gave her a sense of language – inability to talk about her emotions was because her father was never interested.

Brought up to be a ‘belle image’- lack of deep emotion, no true expression.

Oedipus complex: “plainly jealous” – unresolved complex

Psychiatric formulation: analysis of causes for condition, summary of background.

Grid format: predisposing, precipitating, perpetuating, protective; biological, psychological, social

Dominique’s response to affair shocks Laurence

Leads to her sense of ambivalence.

Bearing things?

Marthe: reason for existence – existentialism

Breakdown at the end: interview points to reason; distraught with the world of materialism vs disaster and being a façade, link to existentialism.

Opening of eyes and still in the dark- mole – characteristic for depression

Points for Dx section:

Introduce with list of DDx in order of importance ie depression, anxiety, eating disorder

Test results of questionnaire

All against me part – psychotic? Whats happening here?

Reaction formation – suppression of bad trait, do opposite

Over the following fortnight, we worked hard to edit and perfect our work and upload everything to the website. We allowed time for administration and last minute changes such as crediting pictures. 

 Contributions

Zoe Johnston was responsible for co-authoring the "Causes" section, Introduction and the Synopsis. She was also partially responsible for editing the "Diagnosis" section. Furthermore,  she  researched and found textbooks on the philosophical aspects of the project and completed the Information Search Report.

Joanna Moffatt co-authored the section on "Diagnosis" with most of her work focusing on Eating Disorders. She was also responsible for co-editing the "Causes" section and helping to write the Conclusion. Finally, she looked into feminism and image relevant to the time setting of the book.

Timothy Brook helped to write the Introduction and "Causes" section. He was also responsible for co-editing the "Diagnosis" section and  helped to liase with the tutors. His research mainly surrounded other reviews and the Oedipus complex theme of the book.

Ailsa Campbell helped to write the "Diagnosis" section and the Conclusion, and co-edited the "Causes" section. She was also responsible for the majority of administration, keeping the website up to date and organising meetings. She focused mainly on the multi-faceted disorder of anxiety in her research.

Rufus Turner co-wrote the "Diagnosis" section and the Synopsis, as well as helping to edit the "Causes" section. His key area of work was depression and mood disorder - in particular cyclic disorders. He also completed the quote translation appendix.

Dr Jane Yeoman recommended the text we studied and provided relevant lecture material and expertise on French literature analysis. She also read and provided critical feedback on our work throughout the project.

Dr Lucy Stirland discussed the medical aspect of the project with us and provided expert opinion and suggestions particularly relevant to our "Diagnosis" section.

Information Search Report

In order to complete our project, we had to learn a lot more about mental illness. Following discussion and basic research to point us in the right direction, we decided that we would investigate mood disorders, eating disorders and anxiety as broad categories for Laurence’s differential diagnosis. After concluding that she suffered from forms of both anxiety and depression, we went on to research possible causes for these.

We used a wide variety of resources to find this information. Utilising research techniques that we had learned throughout our university career so far, we created sensitive and specific searches on medical databases such as Pubmed and the Cochrane library. We were critical in our selection of material, attempting to choose only the most relevant journals, textbooks and websites. Below is an example of of a search we carried out.

Medline search for association between depression and gender roles.

As seen above,  we used an advanced search with general terms, which we then combined using Boolean operators to narrow our results. An example of this was searching both mood disorders and depression, which we exploded and combined with "OR". This allowed us to include articles which used different terms for the same topic. We then further specified our search by carrying out the same process for "gender roles",  and then combined these two with "AND" to find articles which discussed the relationship between the two.

Following this we further limited the search to find only more recent articles, based on humans and published in English.

Furthermore, we looked up previous reviews and information about Les Belles Images, in order to see how others had interpreted Laurence’s conditions as well as

the book as a whole. Much of this material was kindly provided for us by our tutor, Dr Yeoman. Having taught Les Belles Images for many years, she had acquired an excellent knowledge of the literature surrounding it.

We encountered a number of challenges whilst carrying out our research. For example, the diagnostic criteria for each mental illness seemed to vary over time and even from resource to resource. We therefore had to be especially critical when selecting material for this area, trying to choose only the most recent articles from the most reputable sources.

 References

Header Image

Les Belles Images on French Flag (Own Work). No copyright required.

Principle text

Original French

De Beauvoir S. Les Belles Images. Mayenne: Éditions Gallimard; 1966.

English translation

De Beauvoir S. Les Belles Images. O’Brian P. London; Wm. Collins Sons and Co. Ltd.; 1968.

Supporting references

Diagnosis

1. GP Practice Notebook – a UK medical reference. ICD-10 depression diagnostic criteria.

[Online] Available from: http://www.gpnotebook.co.uk/simplepage.cfm?

ID=x20091123152205182440 [Accessed 8th February 2015].

2. The World Health Organisation. F30-F39 Mood (affective) disorders, In : The World

Health Organisation (ed.) The ICD-10 Classification of Mental and Behavioural Disorders – Clinical descriptions and diagnostic guidelines. 2015. [Online] Available

from: http://www.who.int/classifications/icd/en/bluebook.pdf [Accessed 8th February

2015].

3. Faillaize E. Les Belles Images, In: The Novels of Simone de Beauvoir. London:

Routledge; 1988. p.118-142.

4. Sharpe MC., Lawrie SM. Medical Psychiatry, In: Walker BR. et al. (eds.) Davidson’s Principles and Practice of Medicine. 22nd ed. Edinburgh: Churchill Livingston/Elsevier;

2014. p.255-256.

5. NHS Choices. Anorexia Nervosa – Diagnosis. [Online] Available

from: http://www.nhs.uk/Conditions/Anorexia-nervosa/Pages/Diagnosis.aspx [Accessed

17th February 2015].

6. Dolan B. Introduction, In: Dolan B., Gitzinger I. (eds.) Why Women? Gender Issues and eating disorders. London: The Athlone Press Ltd; 1994. p.1-11

7. BMJ Best Practice. Panic Disorders - History and Examination. [Online] Available

from: http://bestpractice.bmj.com.ezproxy.is.ed.ac.uk/best-practice/monograph/121/

diagnosis/history-and-examination.html [Accessed 15th February 2015].

8. De Beauvoir S., Stefanson B. (editor). Simone de Beauvoir Présente ‘Les Belles Images’:

an interview with Jacqueline Piatier, In: Les Belles Images. London: Heinemann

Educational; 1980. p.55-61.

9. BPDWORLD. Diagnostic Criteria. [Online] Available from: http://www.bpdworld.org/what-

is-bpd/diagnostic-criteria [Accessed 14th February 2015].

10. Ohio Association of County Boards. Quick Guide to PRIME-MD Patient Health Questionnaire (PHQ).  [Online] Available

from: http://www.oacbdd.org/clientuploads/Docs/2010/Spring%20Handouts/Session

%20220j.pdf [Accessed 14th February].

Causes

1. Cabaniss DL., et al. Introduction to the Psychodynamic Formulation 1, In: Psychodynamic Formulation. Oxford: Wiley-Blackwell; 2013. p.1-8

2. Ward MG., Woollen G. Les Belles Images, In: Keefe T. (ed.) Les Belles Images La Femme Rompue. Sheffield: Juma Printing and Publishing; 1991. p.6-35

3. Smail D. The Tyranny of ‘Normality’, In: How to Survive Without Psychotherapy. England: Constable and Company; 1996. p.329-352

4. Katz SJ., et al. Childhood Social Withdrawal, Interpersonal Impairment, and Young Adult Depression: A Mediational Model. Journal of Abnormal Child Psychology.  [Online] 2011; 39(8): 1227-1238. Available from: doi: 10.1007/s10802-011-9537-z [Accessed 15th February]

5. Brüne M. Human life history, In: Textbook of evolutionary psychiatry. Oxford: Oxford University Press; 2008. p.73-88

6. De Beauvoir S., Stefanson B. (editor). Simone de Beauvoir à propos des ‘Belles Images’, In: Les Belles Images. London: Heinemann Educational; 1980. p.62-65

7. Brüne M. Causes of psychopathology, In: Textbook of evolutionary psychiatry. Oxford: Oxford University Press; 2008. p.88-106

8. De Beauvoir S., Stefanson B. (editor). Simone de Beauvoir Présente ‘Les Belles Images’: an interview with Jacqueline Piatier, In: Les Belles Images. London: Heinemann Educational; 1980. p.55-61

9. Dolan B. Introduction, In: Dolan B., Gitzinger I. (eds.) Why Women? Gender Issues and eating disorders. London: The Athlone Press Ltd; 1994. p.1-11

10.Brown G., Harris T. Life events and depression, In: Social origins of depression: A study of psychiatric disorder in women. New York: Free Press; 1978. p. 100-116

11.Brenner, C. Depressive Affect, Anxiety, and Psychic Conflict in the Phallic-Oedipal Phase.The Psychoanalytic quarterly.  [Online] 1979; 48: 177-197. Available from: http://www.pep-web.org.ezproxy.is.ed.ac.uk/document.php?id=paq.048.0177a[Accessed 14th February 2015]

12.Duchen C. May ’68, In: Women’s Rights and Women’s Lives in France 1944-1968. London: Routledge; 2003. p.190-211

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