John is a physician, and perhaps—(I would not say it to a living soul, of course, but this is dead paper and a great relief to my mind—) perhaps that is one reason I do not get well faster.

The secret that the narrator confides to her journal concerns the paradox of receiving treatment from a doctor who doesn’t believe the patient is ill. Writing down how she really feels, and in this case, what she really suspects about her treatment, gives the narrator relief. Even though she feels she cannot share this suspicion with anyone else—or maybe she already did and had her ideas rejected—she experiences respite from her anxiety in expressing the observation. The fact that her husband/doctor forbids her self-expression shows the lack of understanding that exists between them, resulting in her worsening mental health.

There comes John, and I must put this away,—he hates to have me write a word.

The narrator expresses how she feels when she sees John approach and she must put away her writing. Readers understand that she has been writing this text against the direct orders of John, her husband and doctor, who believes writing weakens her health. Despite respecting her husband’s opinion and skill in general, in her own case she feels she knows better—that writing heals her. Or perhaps she does not know for sure that writing helps, but she cannot help herself. She simply is a writer and therefore must write. When John says he hates for her to write, he says indirectly that he hates for her to be herself.

I think sometimes that if I were only well enough to write a little it would relieve the press of ideas and rest me.

The narrator’s mental health is declining. John, her husband and doctor, forbids her to write under the impression that writing exacerbates her mental instability, but she continues to surreptitiously document her thoughts. In fact, she produces this account, explaining all she goes through during her illness. Now, she attributes her intensifying depression to her lack of energy to write at all. Meanwhile, her thoughts and ideas continue to press in unabated, but she has no healthy way of contending with them anymore. The narrator reaches a point at which only a radical change in treatment will bring her back from mental collapse.

I don’t know why I should write this. I don’t want to. I don’t feel able. And I know John would think it absurd. But I must say what I feel and think in some way—it is such a relief!

The narrator reveals the tremendous struggle she faces—being forbidden by John to write, yet desperately needing to write or even express her ideas aloud. John’s continued discouragement of writing and other forms of self-expression makes the narrator increasingly depressed and thus less able to write, even in John’s absence. Nevertheless, she feels compelled to continue writing this account, when she can, and finds expressing herself a relief. Unfortunately, journaling functions as the only form of relief open to her, since she must otherwise suppress her ideas—even about her own treatment—and this situation proves inadequate to keep her mentally healthy.