Beyond the doctor-patient relationship: Anne Sexton and her psychiatrist, Dr. Martin T. Orne

Revista de Estudios Norteamericanos, n.º 11 (2006) , pp. 81 - 91 BEYOND THE DOCTOR-PATIENT RELATIONSHIP: ANNE SEXTON AND HER PSYCHIATRIST, DR. MARTIN T. ORNE SHIHO FUKUDA Kobe College . Japan 1 The publication of Diane Wood Middlebrook 's Anne Sexton: A Biography in 1991 was a sensation. Sylvia Plath, who attended Robert Lowell's seminar at Boston University with Sexton, and whose life, death, and art, resemble Sexton's in many ways, has bccn the subject of four different biographers,' but Middlebrook's book was the tirst majar biography of Sexton since Caroline King Bamard Hall's Anne Sexton ( 198 7). In the foreword to the biography, Sexton 's psychiatrist, Dr. Martín T. Orne, gave evidence about bis therapy sessions with the poet, and with his permission sorne records from Sexton's therapy tapes were disclosed to the public in the appendi x. lt was inevitable that Middlebrook's book would arouse a certain amount of controversy. The publication of the Middlebrook's biography provoked a keen debate o ve r the issue of therapist-patient confidentiality among the American public. Reacting to thc news that thc book wou ld be published in September, 1991, for instance, The New York Times dated July 15, quoting the words of Jeremy A. Lazarus, the chairman of the ethics committee of the American Psychiatric Association, raised the issue lh at: «A patient's right to confidentiality survives death» (A2, Cl 3). And five days later, 1 The biographies in chronological order are: Linda Wagner-Martin's Sy/l>ia Plath (New York: Simon, 1988), Aune Stevenson's Bitter Fame: A Life of Sylvia Plath (Boston: Houghton. 1989). Paul Alexander's Rough Magic: A Biography of Sylvia Plath (New York: Viking, 1991), and Ronald Hayman 's The Death and Lije of Sylvia Plath (London: Heinemann. 19 91 ). 82 Shiho F ukuda th e same newspapcr published an article «Betrayed: Thc Poet and the Public» with a conclusion: «By taking the tapes, Ms. Middlebrook fo ll owed her profession. But by offer in g them, Dr. Orne dishonored hi s» (Al 8). The argument among psychiatrists, needless to say, was quite harsh. On the one ha nd , so rn e psychiatrists approved of Dr. Ome 's professional decision as Paul Chodoff's article suggests. In a special section about the biography in Joumal of the American Academy of Psychoanalysis, he concluded that «Dr. Orne acted in an understandable, honorable, and ethical manner» (643). Others, on the other hand , fiercely rejected the idea of generous consent. Again in the same issue of the same journal, Josef H. Weissberg claimed that «professional confidentiality ... rested with Sexton's psychiatrist» (638); Judith Viorst argued «patients should be able to count on thc fact that -alive or deadtheir secrets are safe» (652); furthermore, Edmund D. Pellegrino criticized Dr . Orne's act as one «of moral theft» ( 191 ). Whether or not what Sexton's psychiatrist had done was «moral theft» is not a question to be considered here. The point to note instead is the fact that Dr. Orne was an indispensable person for the re construction of the poct, Sexton, and my aim in what follows is to examine the role of the doctor in Sexton 's li fe. To discuss how Dr. Orne related to the poet before and after her dca th would give us a new understanding of his existence in the poet's li fe and help us comprehend Sexton and her poetry more deeply. II lt was in 1956 that Sexton first met Dr . Martín Orne, a psychiatrist and psychologist, whose lifelong work was in hypnosis.2 He receivcd his M.D. from Tufts in 1955, with a Residency in Psychiatry at Massachusetts Mental Health Center, and a Ph.D. in Psychology from Harvard in 1958; as this chronology shows, he wasjust making a start on his career as a practitioner around the time his sessions with Sexton began. Young and inexperienced as he was, the future expert in hypnosis successfully coped with her severe memory problem and trance (dissociative states), which had obstrncted the treatment of the poet's mental illness. He suggested that she listen to the audiotape recorded duri ng the therapy so that she could fill in the discrepancies between what she remembered and the actual things which had happened in the session. The result of his counsel was astonishing: Sexton, by listening to the tapes over and over, learned how to control her anger and pain, and then to surmount these negative emotions. Dr. Orne adopted not only the use of audiotapes but also poetry therap y. It was rather recently that poetry therapy (more commonly known as bibliotherapy) was 2 Dr. Martín Omc's biographical facts are from his obituary in Almanac of University of Pcnnsylvania (« Dr. Martín T. Orne: Psychotherapy Pionecr.» Alma11ac. 22 Fe b. 2000. U of Pennsylvania. 13 Apr. 200 3 <http://www.upenn.edu/almanac/v46/n22/022200.html>.) /J eyo nd tite Do ctor-Patient Relation:./úp: Am ie Sexton ... 83 introduced and developed as a treatme nt for mental illness in the U .S .A. Eli Greifer, a poet, pharmacis t, and lawyer, conducted the first poctry therapy in New York in the ! 950s; the pioneering collection of essays in the field, Poetry Therapy: The Us e of Po etty in the Treatment of Emotional Di sorders, was publi shed by Dr. Jack J. Leedy in 1969; and it was only in 1980 that the Na tional Association for Poetry Therapy was founded by such great experts in the ficld as Ja ck Leedy and Arthur Lemer. We can easily assume that there were no professional st an dard s for the treatme nt when Dr . Orne start ed on poetry therapy with Sexton in the l 960s. Even though there was no standard approach to poetry therapy, however, Dr . Orne effectively utilized the best elcmcnts of the ne w tr ea tment. lt is uncertain if Westwood Lodge, where Sexton met her psyc hiatri st, was enthusiastic about introducing art th erapy, including poetry therap y, to their patients. It would seem, however, that they invited a music in structor for gro up sessions, in wh ic h Scxt on participated at least once, as we see in her poem, « Ringin g the Bells» (28-9): And th is is the way they ring the be ll s in Bcdlam and this is the bell-lady w ho comes each Tuesday morning to give us a mu sic lesson and this is always my be ll responding to my hand that responds to th e lady who po int s at me , E flat; and although we are no better for it, thcy tell you to g o. And you do. Allhough the patients «are no better for it [i.e. r in ging the bells],» the narrator says, the music in stmctor urges them «to go,» that is, to pl ay each of their bells, and th ey fo ll ow her instruction. For the im portant thing is that the patients share music with the instructor in the group session; a nd that the tim e a nd sp ace filled with music (or art) can aid thc patients to realize they are a part of the world. Dr . Orne employetl poetry writing in Sexton's therapy in a manner similar to that of th e music instructor in the poem; in conse qu ence, he !et her define who she was and feel that she was a part of , an tl integrated with, everything existing in the wo rl d. According to the biography, Dr. Orne «did not discuss Sexton 's poems with her as sources of ins ig ht into psychologi ca l problems» (Middlebrook 43), which was, in fact, th e appropriate approach for the patient who was trying to regain her self-esteem.1 1 One of 1he r ece nt praclitioners of poelry therapy states that «criticizing u sua ll y isn't help fu l unless it a<lds somcthi ng to thc piece» (Alschuler 114); it can be sa id that Dr. Orne graspcd the axis of thc way of conducting poetry therap y. 84 Shiho Fukuda The poem «Elizabeth Gone» provides us with a good example of the succe ss of Dr. Orne's way of treatment: You lay in the nest of your real death, Beyond the print of my ncrvous fing ers And somewhere you cr ie d, let me go let me go. (8) The woman, Elizabeth, to whom Sexton talks here, is the persona w hich manifested its elf while she was in trance. From nowhere, the place where the poet could not reach ( «Beyond the print of my nervous fingers» ), Elizabeth appeared and asked the poet to «/et [her] go» out of «the nesb> she was confined in, namel y, inside her. Yet Dr. Orne did not allow the fantasy of Elizabeth to develop within Sexton. By insisting that «"Elizabeth" expresses a side of [her] childhood which showed sorne assets [she] nev er really owned» (Middlebrook 61), he persuaded her to avoid the feelings she wanted to act out as Elizabeth. The change in Sexton's involvement with the Elizabeth persona is easily found in the othcr parts of th e pocm. Whereas she says in the first stanza that Elizabeth cried, «let me go !et me go,» she replaces the subject by «something» in the n ex t stanzas: «Something cried, let me go /et me go» (8). To put it simply, the persona, which us ed to be another self of the poet, is degraded to a material being Lhat can becorne the object of a diagnosis. Possibly, Sexton was composed enough to face and observe Elizabeth. The poern concludes: «Then 1 sorted your clothes I And the !oves you had left, Elizabeth, I Elizabeth, until you were gone» (9). Every sentence is written down in the past tense; when completing this poem, therefore, Sex to n succeeded in separating herself from the Elizabeth persona. The false self «[was] gone» o ut side of her through the effmt of Dr. Orne and herself; and at the same moment, she repossessed her own self. Sexton believed that the only thing she could do well was «to be a good prostitute» (Middlebrook xiii) when she met Dr . Orne for the first time. However, as the poem above implies, Sexton gradually broke th rough a lack of self-respect with the help of creative activities. And Dr. Orne's continuous encouragernent resulted in the discovery of her inner resources as a poet; in this sense, Dr. Orne became one of the most indispensable figures in Sexton's lif e and art. IlI Let us now move on to the examination of the work in wh ich Sexton reveals her admiration for Dr . Orne. O ne of her well-cited poems, « You , Doctor Mart ín » (3 -4) , reads as follows: Beyond the Doctor-Patient Relationship: Anne Sextorz ... You, Doctor Martín, walk frorn breakfast to madness. Late August, 1 speed through the antiseptic tunnel where the moving dead still talk of pushing their bones against the thrust of cure. And I am queen of this summer hotel or the laughing bee on a stalk of death. We stand in broken lines and wait while they unlock the door and count us at the frozen gates of dinner. .. What Jarge children we are here. Ali over 1 grow most tall in the best ward. Your business is people, you call at the madhouse, an oracular eye in our nest. .. 85 The tone of the poem is cynical about the mental institution and about Dr . Orne's profession. In Sexton's eyes, the patients including herself look like «moving dead» without a soul, and her doctor deals with thern only to complete his «business.» There is no human relationship between the psychiatrist and his patients. And Sexton calls her psychiatrist «Doctor Martín» instead of «Doctor Orne,» which irnplies her wry attitude towards the doctor. While he is a respectable person who takes care of rnany patients' rninds, he is also a social being who can be called by his first narne. It is obvious that Sexton had bitter feelings towards the hospital systcm and towards her psychiatrist. M. L. Rosenthal, an advocate of the idea of «confessional poetry,» states that «confessional poetry is a poetry of suffering» (60). Sexton's above-mentioned poern is an accurate description of her «suffering» as a pa ti ent in a mental institution. Yet even if he was not agreeable as a person to the sick poet, Dr. Orne was a central figure in her life as a writer from the beginning of their meeting as we have already seen. Also, it is well-known that Sexton's mother, Mary Grey Harve y, prevented Sexton from becoming a poet (or even an amateur writer) because of her cornpetitive tendency, and that Sexton consequently stopped writing as a hi gh school girl, being afraid of hurting her rnother's feelings. Then, for Sexton, whose Jiterary talent had been denied by her kin, Dr. Orne carne into sudden promincnce as a kind of savior, who encouraged her to write and purse her latent literary tale nt. Contrary to her ironic rernarks in the poem, Sexton was indebted to Dr. Orne for his encouragernent to write poetry, and that is why her first collection of the poems, To Bed/am and Part Wa y Back, opens with this poem, a call to h er psychiatrist. lt is possible that Sexton naturally regarded Dr. Orne as the person who understood her the bes t. 86 Shiho Fukuda This ca n be further clarified when we read the p oe m « The Doctor of th e Heart ,» written after Dr. Orne tenninated hi s th erapy session with Sexton due to hi s move to Philadelphia: Take away your knowledge, Dokt or. Jt doesn 't butter me up . You say my heart is sick unto. You ought to ha ve more respec t! (301) The poem is included in the vo lum e The Bo ok of Folly, published in 1972, wh ich is eight years after Dr . Orne left Boston; quite possibl y, Sexton addresses another doctor, Dr. Constance Chase, here.4 The use of a Ge rman word, «Doktor ,» clea rl y shows that the doctor is a target of Sexton's humor. Compared to Sexton, a high school dropout and moreover, a mentally ill per so n, the doct or has a lot of «knowledge.» But she is now a Pulitzer Prize winn er am i an instructor in poetry at Boston Un ive rsit y; moreover, she is a human being just as the d oc tor. Hence the poem cri ti cizes the d oc t or , demanding that she should get « mor e resp ec t. » At the end of the poem, the poet declares her definite infidelity to t he doctor in a metaphorical expression: I am at the ship 's pro w. I am no longer the suicide with her raft and paddle. Herr Doktor! I'll no longer die to spite you, yo u wallowing seasick grounded man . (302) For her, a patient of manic depression, d ea th was a sour ce of titilla ti on and fasc in ation. She boldly confesses her suicida! wish in one of her essays about her friendship with Sylvia Plath: « We ta lk ed death with burned-up i nt ensity, both of us drawn to it like moths to an electric light bulb. Suck in g on it !» (No Evil Star 7). Also, h er poem «Wanting to Die» says: «[S]uicides have a special language. / Like carpenters they want to know which too/s. / They never ask why builc i» (142). It is hard to ev ade death for the poe t, because she is destined to comprebe nd its «special language.» ' The relationship between the d oc tor s after D r. Orne am i Sext on d id not work vcry wc ll: Dr. Ollie Zweizung hadan affair with her , which made it impossible to continuc the therapy; the next doctor, Constance Chase, accepted the position as the poet's therap is t on co ndit io n that the poet would ncvcr see D r. Orne. who had been coming back to Ma ssachusells now and then to see his old patients. lt is plausible. from the date, that the doctor in the poem indicates Dr. Chase. Beyond the Doctor-Patielll Relationship: Anne Sexton . .. 87 In this manner, Sexton is not scared of sta nding «at the ship's prow» while the doctor, a non-applicant of death, is «Wa llowing» owing to seasickness caused by heaving seas and chooses to be «grounded» in the end. Hall is right when she maintains that the poem «O ffers a defiant verbal gesture which says to the 'doctor' and everyone, go away» ( 119). Se xton is «no longer the suicide» who stands «at the ship's prow,» holding fast to « her raft and paddle » for survival. She is ready to die at the time when she chooses to commit suicide; «her raft and paddle,» namely, the help from the psychiatrist, are not necessary any more. This poem totally negates the significance of the doctor: doctors other than Dr. Orne would not do. In another poem, «Flee on your Donkey,» Sexton delineates her admiration for Dr. Orne: he «promised me another world /to tell me who J 1 was» (100). She admitted the psychiatrist to be a person who foresaw her way of establishing her identity and urged her to achieve great success in the world of letters ( «another world» ). Here, we see their connecti on beyond the doctor-patient relationship. John Holmes, William D. Snodg ra ss, Robert Lowell, George Starbuck, Maxine Kumin, Sylvia Plath -these people associated with and gave some insights to Sexton as fellow poets or mentors. But it would be no exaggeration to say that Sexton's lif e as a poet was generated and matured by Dr. Orne. Without him, she cou\d not have regained her interest in po etry, continued writing, nor could she have written many of her best poems in which Dr. Orne is depicted. And above all, such a crcative life helped her to hang on to the self-identity she regained with his help. IV Sadly, Scxton took her own life ten years after Dr. Orne left her. Obviously, hi s absence affected her tremendously, as Dr. Orne himself acknowledged. We read his conclusion to the foreword to Middlebrook's biography as follows: «Sadly, if in therapy Anne had been encouraged to hold on to the vital supports that had help ed h er build the innovative career that meant so much to her and others, it is my vi ew that Anne Sexton would be alive today» (xviii). He might have been one ofthe causes of Sexton's suicide, however, it is also true that he was instrumental to her survival even after her death: he disclosed her session tapes to the public in Midd lebrook's biography, which resuscitated the poet, Anne Sexton. In fact, Sexton was quite lucky in that Middlebrook 's biography appeared in print without any censorship before publication. Tbe biographer s' attempts are frequently obstructed by the objects' families and friends, who hope to protect themselves. One of the notorious examples is the case of Sylvia Plath. Her husband -and also a famous poet-Ted Hughes, discarded Plath 's unpublished writings in a dubious 88 Shiho Fukuda manner, as bi s defensive words in the «Foreword» to Th e J ournats of Sylvia Plath indicates: The joumals exist in an assortme nt of notebooks and bunches of loose sheets .... Th e la st of these [i.e. tw o more notebooks] contained entries of sev era! mo nths, and I destroyed it because I did not want her children to have to read it ... The other disappeared. (xiii) His wife's suicide partly related to his flirtation; it is understandable that Hughes did not want to leave all of her joumals. Still, this is a great Joss. In The Unabridged Journals of Sylvia Plath: 1950 -1962, published in 2000, the editor claims: «Sylvia Plath speaks for her se lf in this unabridged edition of her journals» (ix). But even if the new edition includes two joumals that Hughes finally unseal ed jus t before his death in 1998, the parts he «destroyed» are lost forever. Ted Hughes' sister, Olwyn Hughes, has also tried to keep Plath's biographers at a distance. Anne Stevenson, a biographer of Plath, for example, told Janet Malcolm: The image I have of myself and Olw yn is of me sitting happily at my desk writing, with Olwyn looking over my shou lde r. Every time she doesn't like wha t I write she shoves me off the chair and takes up the pen herself. (Malcolm 8 1-2) And as a matter of fact, Olwyn Hughe s' fierce intervention in Stevenson's completion of the biography made it ~<an imperfect, compromised thing» (Malcolm 105) in the end. Thus, the people around Plath have struggled over her personal documents for their own sake, as a result of which we can never get the whole figure of the poet. Compared to Plath 's biographers, those of Anne Sexton have a clear advantage when it comes to obtaining materials. Her daughter, Linda Gray Sexton, who was appointed to be her mother's literary executor on her twenty-first birthda y, is extremely cooperative with biographer s. Being a writer herself, it might be a little easier for her to be generous about unveiling the hidden parts of her mother's life. In her memoir, she frank.ly ta lks about (auto)biography: «To write about Mother and me would enable me to take control of the demons in side and Jet them know who was boss» (Searehing for Merey Street 296). Unlike Ted Hughes, Linda Sexton had no responsibility for the poet's death. Ali she needed to do was to outlive her painful past concerning her mother. Accordingly, even when someone other than herself wrote about her mother, she felt that she could «exorcise Mother» (Searehing for Merey Street 296) by reading a hurtful story and overcoming grief. Beyo nd the Doctor- Pa tient Relationship: Anne Sexton ... 89 One of Linda Sexton 's articles in The New York Times un covers Linda Sexton's courageous attitude towards living as Anne's daughter: « You have already writt en a great deal that is painful,» I wrote Diane Middlebrook in July 1990 ... « We (i.e. family members) were all hurt by having li ved through her life bes id e h er, beyond her, in her shadow. The only way to transce nd the hurt is to tell it ali, and to tell it hon es tl y.» Only writing and reading everything co nceming her mother enabled her to overcome the painful memory. That is to say, any truth revealed in biographies could be acceptable for h er own sake as well as for her mother's. As a result, she agreed with no objections to Dr. Orne and Middlebrook's suggestion that they disclose her mother's session tapes. In this way, under the literary executor's protection -and because of Dr . Ome's enthusiasm for uncovering the true Sexton-the poet 's audiotapes for therapy were released, which brought her back to life. As noted at the be ginning of this paper, Dr. Orne was condemned for tuming over the tape recordings. However, his statement in his letter to The New York Times should be given serious consideration: Anne Sexton chose disclosure of her therapy in keeping wit b wh at she stood for as a confe ss ional poet. .. Sharing her most intimate thoughts and feelings for the benefit of others was not only her expressed and enacted de sire, but the purpose for which she lived. Ali he did was to respect what Sexton had hoped to do most as a poet and to fulfill her intention. Th e question of professional ethics on the part of a psychiatrist is indeed a controversia! issue. Yet Dr . Orne was not inconsiderate of the privacy of Sexton and her family by any means; on the contrary, he was sensirive enough to understand their feelings. It is re asonable to co nclude that Dr. Orne, who developed the poet Sexton in her lifetime, continucd to support her after her death as well. V Middlebrook gave h er opinions on the completion of the bi ography: 1 co uld not talk to her (i.e. Sexton), but on th e tapes she s poke for more than 300 hours -as if to me, or so it often felt-about the transition she was making in 1961 - 64 from housewife an<l mother into prize-winning poet. ( «The Poet's Art» A26).