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Literary expressionism focuses on a character's state of mind, presents symbolic characters, and uses tableaux--all of which Williams incorporates into the final scene of A Streetcar Named Desire when the doctor comes to take Blanche away. Visual and sound techniques combine to reveal Blanche's failing grip on sanity and reality. When she realizes the doctor isn't her fantasy beau, Shep Huntleigh, the polka music plays to reveal Blanche's disturbed state of mind. This technique has been used before, but here Williams has the music "filtered into a weird distortion, accompanied by the cries and noises of the jungle." In addition, when the Matron speaks, her words echo and reverberate in the form of "other mysterious voices." This creates the feeling of Blanche's fragile mental state. In addition, when Blanche rushes back into the bedroom, "lurid reflections appear on the walls in odd, sinuous shapes." Again, this is an outward depiction of the state of Blanche's mind, allowing viewers to experience her emotions with her.
The Matron and the Doctor are symbolic characters who are not represented as realistic people. The Matron "is a peculiarly sinister figure in her severe dress" who has no vestige of femininity about her. In contrast, the Doctor represents the kind stranger, the type of person Blanche says she has always depended on. Blanche fights and scratches against the severe, unsexed woman, but she allows herself to be led away by the kind man. This emphasizes how Blanche cannot be reached by harsh condemnation but only through gentle sympathy, inspiring the audience to empathize with her at the end no matter how much they may have judged her earlier in the play.
Finally, Williams even works in a moving tableaux: After the doctor says "How do you do?" Blanche stops on the stairs next to Stella. The group of three women--Blanche, Stella, and Eunice--huddle together on the stairway in the bond of female powerlessness while the only sound is the shuffling of the cards in Stanley's hands. Stanley holds all the cards--none of the women has the power to defy him. This brief tableaux powerfully communicates the injustice and lack of freedom the women face in their male-dominated society.
The expressionist techniques Williams uses in the final scene allow viewers to sympathize with Blanche to a greater degree and to become even more outraged at Stanley and the culture that winks at abusers of his ilk.
When the doctor arrives in the final scene to take Blanche away, Williams's stage directions call for the "varsouviana" to play in the distance. This "rapid, feverish polka tune" both reflects Blanche's inner turmoil and evokes her shady past, since the boy she was in love with killed himself after they danced the varsouviana together. During the dance, Blanche had told the boy that she knew about his homosexual relationship with an older man and that she was disgusted by it. Along with the music, visual images also appear in the form of "lurid reflections" on the walls in "odd, sinuous shapes." The shadows suggest confusion and violence and recall Stanley's rape of Blanche in the previous scene.
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