Tuesday, July 26, 2011

A Real Love for Big Cheats: The Truth Crimes of Daddy’s Little Bitch

The night of my cousin's wedding
I wore blue.
I was nineteen
and we danced, Father, we orbited….

Mother was a belle and danced with twenty men.
You danced with me never saying a word.
Instead the serpent spoke as you held me close.
The serpent, that mocker, woke up and pressed against me
like a great god and we bent together
like two lonely swans.
--Anne Sexton, from “How We Danced

Theme Seven:  Incest and Molestation

When Anne Sexton first displayed the “Elizabeth” personality, she constantly talked about something that Sexton herself couldn’t say.  In one of her typed-in-the-dark letters to Dr. Martin Orne, “Elizabeth” exhorted the shrink to administer sodium pentothal so that Anne would tell him some deep dark secret.

Sodium pentothal is a barbituate that doctors might give to a patient for a number of reasons.  They can use it as anesthetic, to inhibit phobias, or to induce a coma.*   But here, Anne/Elizabeth is asking for its use as “truth serum.”  The purpose here would be similar to that of a criminal suspect begging to take a polygraph.  Both the suspect and Sexton want their examiners to believe that they‘re speaking the truth.

“Elizabeth” specified that she wanted Dr. Orne to administer the drug to Anne so that the latter could finally talk about something that was at the core of her psychic injuries:  her turbulent relationship with her alcoholic father, and the degeneration of her relationship with Aunt Nana.  

If you’re wondering why Dr. Orne might not believe Sexton if she talked about something exceedingly personal, it’s because Sexton admitted to deliberately lying about her past:  transgressions she frequently referred to as “truth crimes.”  In one instance, she told Orne about an incident she had on one summer vacation when, as a little girl, she was raped by a family friend.  In the next session she claimed that she had deliberately made up the story on the spot--sort of an improvisatory narrative, if you will.  As she herself once said:
I am nothing, if not an actress off the stage.  In fact, it comes down to the terrible truth that there is no true part of me. . . . . . It is as if I will permit my therapy and think it all very interesting as long as it doesn’t touch me.  I am a story-maker, a--doesn’t it strike him as odd that this ‘story’ is too pat?”
This posed a problem in assessing the veracity of what Sexton said in treatment.  It’s for this reason that nieces Lisa Tompson and Mary Ford objected to Orne’s release of the tapes in the first place.  Even in context one could consider them possibly defamatory, especially because of the explosive nature of this secret that Anne wanted to hide, but “Elizabeth” wanted to expose.

During the initial appearance of the “Elizabeth” persona, Dr. Orne noticed the increasing use of the epithet “little bitch.”  Moreover, he began to associate it with “Elizabeth,” but not Anne.  In probing this further, Sexton lapsed into a trance, where the following revelation took place:
Sexton:  Father comes in drunk; wakes me up, saying ‘I just wanted to see where you were--your sister [Jane] is out letting someone feel her.’  And he says it again.  Sits on the bed, takes a bottle out of his pocket and drinks.  I asked where Mommy was; gone to bed and locked the door.  He says, ‘Do you like me?’

Orne:  What side of the bed is he sitting on?
Sexton: [Points with finger.] He asks me if anybody ever felt me.  I don’t know what he means.  I lay down and cuddle with Nana.  I know that isn’t good, I shouldn’t.

Orne:  Shouldn’t what?

Sexton:  He is holding me.  He says to press up against him, sort of wriggles and asks if I like it.  And it feels good.

Orne:  Does he say you are a good girl?

Sexton:  He puts his hand on me and asks if I--if I ever do this and did I ever do it.

Orne:  What did you tell him?

Sexton: [Shakes head]:  He kissed me on the lips and he started to leave and I held on and didn’t want him to go.  Then he came back, left his bottle on the table.”
Here, Sexton accused not just her father, but her Aunt Nana of sexually abusing her.  Once conscious of this, Sexton explored the theme of incest in her writing.  The subject rings as clearly as a bell in such poems as “How We Danced.”  It also serves at the core of her play 45 Mercy Street, a pivotal scene in which depicts a freshly adolescent girl (thirteenish) being intimately fondled by her father, while an elderly woman (reminiscent of Aunt Nana) listens in from the next room. 

Dr. Orne said that he did not automatically believe the allegation.  He subsequently interviewed family members to see if Sexton’s claim of childhood sexual abuse had any merit, and found that  others could corroborate a noticeable friction between Sexton and her father.  After all, Ralph Harvey not only drank, but was excessively formal inside the home.  Sexton found herself rebelling against these tendencies early and often.  But Orne wanted to know specifically if any of this friction between parent and child were sexual.  Sexton’s mother confirmed that her father could be somewhat crude with her.  For example, she told of how Anne, then seventeen, was about to leave the house for a date dressed in a sweater blouse and skirt, when her father asked her, “Are you planning to get laid?”**  Sexton had told the same tale to Orne shortly before.

Sexton’s friends had different opinions as to whether or not her father actually molested her.  One close friend, a psychiatric social worker named Lois Ames, stated with confidence “I could never believe anything but that Anne was a victim of child sexual abuse by both Nana and her father  [emphasis original].   Maxine Kumin, however, disagreed, characterizing the notion as more of a “dramatization,” similar to other “truth crimes” she had told to Dr. Orne in therapy.   As our friend Susan wrote in an earlier post in this series:
Anne strikes me as someone who didn't live in her body much, so she acted out in order to feel something--irresponsible sexuality and self abuse made her come back into her body for a while--she lived more in her head.

Or as Dr. Diane Middlebrook wrote:
“…once she had put a memory into words, the words were what she remembered.  Thus she could give dramatic reality to a feeling by letting it generate a scene and putting that scene into words for Dr. Orne while in a trance.”
In other words, this premise hypothesizes that Sexton created fictional characters (similar to Elizabeth) based on herself.  This gave them a verisimilitude, but they nevertheless remained fictional characters, with fictional histories.  Because of mental illness (or poetic license?), Sexton might not have been able to distinguish her characters from herself.  Thus if she told a story of childhood sexual abuse at the hands of her father and aunt, would that have originated in fact, or fantasy?

Sexton herself seemed to question the actuality of the memory, but seemed quite certain that it was, at least, based on some real aspect of her relationship to her father:
Sexton:  I couldn’t make all this up, or I don’t exist at all!  Or do I make up a trauma to go with my symptoms?

Orne:  There wasn’t a simple cause; it’s something that happened many times without its necessarily happening just this way.  When your father was drinking he was communicating something to you.

Sexton:  Disgust.

Orne:  Or attraction.

Sexton:  Sitting beside Daddy, his saying I can’t eat when she’s at the dinner table--I thought pimples were a sign of things inside that were showing.

Orne:  Your feelings about him?
The tapes Dr. Orne submitted to Dr. Middlebrook gave every indication that he thoroughly believed the story at face value at that time.  He acted as if the allegation were true, prompting him to explain to Middlebrook:
I dealt with it in therapy as a real event, because there were times that it was real to her.  Anne, like most patients with this kind of disorder, easily adopted pseudo-memories in treatment which are experienced with great vividness, and their treatment may help the patient even though the events may never have occurred.  If you ask me either as a psychiatrist or as a scientist, however, I would have to say I am virtually certain that it never occurred.  It’s not plausible the way she described it, and it wasn’t the father’s style when he was drinking.  But it fit her feelings about her father having abused her, and since she sexualized everything, it would become the metaphor with which she would deal with it.

Whether or not the sexual abuse actually occurred, one could say that this psychiatric disclosure might have indicated something more pertinent to Sexton’s sexuality.  During the writing of Anne Sexton, Linda Gray Sexton told Dr. Middlebrook that Anne sexually abused her.   Linda gave further details about this in her 1994 memoir, Searching for Mercy Street:  My Journey Back to My Mother, Anne Sexton, in which she frankly discussed such things as very intimate bedtime touching (similar to what Nana supposedly did to her mother), and Anne’s tendency to masturbate in front of her.

Personally, I don’t like to take anything at face value, and am loath to state something as fact based on a single source--unless the source happens to be me.  At the same time, I’m in no position to question Linda Sexton’s memory or account of these incidents.  And what she says does make sense in a way.  If her mother had been sexually abused as a child, then that could conceivably put her at greater risk for sexually abusing her own kid. 

This incestuous behavior allegedly began shortly after Dr. Orne left the Boston area to teach at the University of Pennsylvania, thus making him unable to continue as Sexton’s main shrink.  Although the timing might make his leaving seem like a causal factor, this could have been due to the fact that Linda had just begun her adolescence, and was consequently developing into maturity.  At the same time, however, even though he was no longer her psychiatrist, Dr. Orne continued to see Sexton once a month for several years, and maintained contact with her until 1973, about a year before her suicide.  One thus has to wonder how he reacted when she disclosed this to him, or if she disclosed it to him at all. 

_____________________
*It’s also used, in combination with other drugs, to kill condemned prisoners during lethal injection.

**The wording is that of Sexton’s mother.  Sexton herself remembered the question as “Are you planning to get fucked?”

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Thursday, July 21, 2011

A Real Love for Big Cheats: One Hysterically Funny Memory of the First Certain Thing

Theme Five:  Death
O Sylvia, Sylvia,
with a dead box of stones and spoons,
with two children, two meteors
wandering loose in a tiny playroom,
with your mouth into the sheet,
into the roofbeam, into the dumb prayer....

Thief --
how did you crawl into,
crawl down alone
into the death I wanted so badly and for so long,
the death we said we both outgrew,
the one we wore on our skinny breasts,
the one we talked of so often each time
we downed three extra dry martinis in Boston,
the death that talked of analysts and cures,
the death that talked like brides with plots,
the death we drank to,
the motives and the quiet deed?
--Anne Sexton, from “Sylvia’s Death
As should be clear by now, there were myriad contributing factors tied to Anne Sexton’s suicidal tendencies.  There was the feeling of entrapment that came to the fore after her marriage to Alfred Sexton, and increased after the birth of her children.  There was also a constant preoccupation with her own madness. She often wondered if she would wind up like her Aunt Nana, whose dementia led her to spend her final years institutionalized.  As Sexton iterated during a taped session:
Sexton:  Well, I said to Kayo, ‘Please don’t let them give me an shock treatments.’--Because she just got better, then she got sicker; they didn’t do her any good--Maybe I’m like Nana; she really just wanted Mother.  I think that something very [unintelligible] was hard for me, you know, because she had been my mother in many ways--She got sick and just wanted to be my mother’s child; she kept saying my mother’s name under her breath, ‘Mary, Mary Gray,’ every single minute.  Every time she said it, it meant ‘You’re not my child, I’m your mother’s child.’   And actually, as you said, I got sick when my mother went away.--When Nana died, I was pregnant with Joy;  after that, when Joy was six months old, Mother went away--it was a combination of things--probably I am like Nana.

Orne:  But you are not Nana.

Sexton:  Why would I try to become Nana?  That doesn’t make any sense:  I try to become Nana in order to kill her?

Orne:  In order not to lose her.  It’s what we do when we can’t let people die.

Sexton:  I become the Nana I didn’t want, which I suppose I thought was better than nothing, after she died.--Maybe I come from a morbid--just inherited this.  My father was really rather depressed, even though he didn’t seem it, he was depressed.--And Nana, who was so active and intelligent and warm, that’s what happened to her....
While Sexton's preoccupation with death became apparent during adolescence, Dr. Orne saw it, in a weird way, as healthy.  As he wrote for Dr. Middlebrook:
Anne also had a remarkable fascination with death, and it seemed likely that she used some of the trance episodes to play the role of dying, which perhaps helped her not to suicide.

As expressed in “Cigarettes and Whiskey and Wild, Wild Women,” Sexton often saw herself as a rat, her metaphor for own sense of worthlessness.  Also, as the poem would suggest, her self-destructive tendencies in part originated from the self-loathing that had become a part of her.  It also suggests that she saw death as a panic button, of sorts.  If she found that she could no longer bear the weight, responsibility and stigma of being the spokes poet for the mentally ill, she could end it all whenever she chose.  In this respect, Sexton might have seen controlling her death as an important part of controlling her life. 


Theme Six:  Memory lapses

One of the most difficult things Dr. Martin Orne initially had to deal with, according to him, was Anne Sexton’s “severe difficulty of memory.”   He said that she couldn’t remember things that they had discussed “from one session to the next.”  This led him to conclude that she suffered from “…a condition that traditionally was known as hysteria.”

Hysteria?

Mind you, Dr. Orne wrote this in the foreword of Dr. Diane Middlebrook’s 1991 biography, Anne Sexton.  So, we have to wonder why he gave us such a quaint nineteenth-century diagnosis.  Traditionally, doctors believed that women had certain mental illnesses because of troubles with their reproductive organs.  Okay, she’s in the loony bin for post-partum depression.  But did he actually believe that Sexton's uterus turned her suicidal?

Hysteria had always been a vague diagnosis, with an exhaustive list of symptoms that could apply to just about any sane or healthy organism regardless of gender.  Subsequently, over the past 100 years or so, psychiatrists and other mental health researchers have broken down some of the more common and pathological manifestations of this malady into a number of different diseases, as defined by DSM-IV.*  Most of these fall under the general rubric of dissociation, but several seem more directly applicable to Sexton:  depersonalization disorder, dissociative identity disorder, and dissociative amnesia.

My guess is that Dr. Orne was referring to that last illness when talking about Sexton's poor memory.  Still, if Sexton were that prone to memory loss, especially on a persistent basis, one might guess that it would have been an issue both in and out of therapy for all of her life.  That would mean that she would have difficulty learning new things.  Certainly this would be a tremendous handicap if in a college course or workshop where the moderator or professor cannot simply go back over all the material covered in the previous lecture.  Other than Orne, no one seemed to have characterized this as a condition that dominated their relationship with her.**

Dr. Orne explained that while in psychoanlysis, Sexton would spontaneously lapse into trance states, where one part of her would interact with him and continue to maintain progress, while her conscious mind had wondered off to who-knows-where.  He became exasperated with:
...her tendency to become uncommunicative in a self-induced trance, which could last minutes, hours, or, in a few rare circumstances, even days.  Typically, the trance episode could easily be ended by a therapist familiar with the symptom.  But in therapy and out, the problem persisted:  when Anne was extremely angry, she was given to entering a trance and becoming unresponsive….

In order to maintain some consistency from one session to the next, Dr. Orne tried several things to help her remember what went on during their previous meeting.  First, he had her take notes.  But that disrupted the normal rhythms of therapy.  Next he tried tape recording the sessions.  Yet her review the tapes yielded the same results as before:  no memory of what happened during psychoanalysis.  He then hit upon a combination of tape recording and note taking that seemed to do the trick:
First we would audiotape the therapy session, and afterward Anne was asked to make extensive notes about everything she could remember from the session.  The next day she would come to the office, and my secretary would put the tape on the recorder and leave her alone to listen to the session.  She was asked to note particularly the discrepancies between her memories, her notes from the previous day, and what actually happened on the tape.  In the beginning, it was necessary for Anne to listen to the audiotape twice before she was able to recall on her own what we had dealt with during the session.  This tedious approach demanded a great deal of Anne, but its consequences were profound.  For the first time in her life, she was able to recall why she had been angry at me, without knowing the reason.  In other words, Anne could really remember and learn about her feelings, whereas in the past she had been unable to recall more than fragments of what occurred--many of which she recalled incorrectly.
Curiously, Dr. Orne admitted that once Sexton got the hang of this process, she began to correct his memory lapses during therapy.  He subsequently realized she was right when he played the tapes back for himself.

 ________________________
*This would have also been true for DSM-IIIR, the edition Orne would have used as reference in 1991. 

**Her friends and family would, however, speak openly about what they perceived as Sexton's tendency toward memory distortion, which is another issue.  I'll discuss that later. 

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Saturday, July 16, 2011

A Real Love for Big Cheats: Inferiority and Entrapment


Theme Three: Feelings of Worthlessness
Now that I have written many words,
and let out so many loves, for so many,
and been altogether what I always was—
a woman of excess, of zeal and greed,
I find the effort useless.
Do I not look in the mirror,
these days,
and see a drunken rat avert her eyes?
Do I not feel the hunger so acutely
that I would rather die than look
into its face?
I kneel once more,
in case mercy should come
in the nick of time.
--Anne Sexton, from “Cigarettes and Whiskey and Wild, Wild Women

Early in their sessions, Dr. Martin Orne asked Anne Sexton what special talents she had, and what endeavor she would be most suited for. After some thought, she replied that she would make an excellent prostitute, because she had a real talent for making men feel powerful. The response immediately got Orne’s attention as perhaps the overriding theme of Sexton’s sessions. In the foreword of Anne Sexton, he wrote:
I sought to explore Anne’s resources and goals. She had married early and had barely finished high school. She particularly regretted her lack of formal education, which contributed to her feelings of inadequacy. It is difficult to communicate fully how pervasive Anne’s profound lack of self-worth was and how totally unable she was to think of any positive abilities or qualities within herself [emphasis Orne]

Dr. Orne felt it imperative that Sexton intellectually develop herself, and thus strongly urged her to enroll in college. She didn’t think college was for her, so Orne suggested that she write.* Sexton chose poetry as her primary medium. According to him, he read these early poems, but did not comment on their content or quality. The point, for him, was to convince her of her own potential, which he felt confident was substantial given the high IQ scores she achieved on the tests that he administered. He then gave these early drafts to one of his Harvard colleagues, an English professor, for an appraisal.  As a layman he thought the poems were impressive, but didn’t know for sure. This unnamed professor friend affirmed that they were in fact quite good, and told Orne that Sexton should seriously pursue poetry.

Despite the success that poetry brought her, Sexton continued to see herself as essentially ugly and vile. She sometimes metaphorically referred to herself as a rat with destructive tendencies, as she did in the work titled “In the Deep Museum,” a poem told in first person from Christ’s point of view. These feelings of inadequacy also played a part in her suicidal fantasies.

Another source of her self-deprecation lay in her identification by self and others as a mentally ill person. Along with the stigma (especially during the 1950s and 1960s) of mental illness came the worry, the fear, the dread that like the other destructive and self-destructive persons institutionalized with her that she too was as particularly loathsome and dangerous, a theme she explored in “Flee on Your Donkey” and others poems in To Bedlam and Part Way Back.



Theme Four: Entrapment
The chief ingredient
is mutilation.
And mud, day after day,
mud like a ritual,
and the baby on the platter,
cooked but still human,
cooked also with little maggots,
sewn onto it maybe by somebody's mother,
the damn bitch!….


Is life something you play?
And all the time wanting to get rid of it?
And further, everyone yelling at you
to shut up. And no wonder!
People don't like to be told
that you're sick
and then be forced
to watch
you
come
down with the hammer…..


I promise to love more if they come,
because in spite of cruelty
and the stuffed railroad cars for the ovens,
I am not what I expected. Not an Eichmann.
The poison just didn't take.
So I won't hang around in my hospital shift,
repeating The Black Mass and all of it.
I say Live, Live because of the sun,
the dream, the excitable gift.
--Anne Sexton, from “Live

One thing that repeatedly comes up in Sexton is her inability to fit into the roles that others have cast for her. From her perspective, life represented a number of obligations and responsibilities that ate away at her: marriage, family, domestication. In “Live,” Sexton pondered whether it would really be better to live than have to face daily what she saw as suffocation and suppression.

In some ways, this sentiment endeared her to some of her female readers, who also thought that this mandatory lifestyle offered slim chance of escape without grave censure (or worse) from parents, friends and family. One has to remember that during the 1950s and 1960s, economic prosperity allowed for a number of single-income families, and working women were not only often seen as embarrassment (I actually remember people saying such things back then as “Your wife has to work?”) or failures (e.g., “Poor thing, can’t catch a husband”). Many were otherwise stigmatized as poor mothers, who, failing to recognize their place in society (i.e., the home), did who-knows-what kind of long-term damage to their children.

Anne didn’t simply imagine the pressures on her to conform, although one could definitely argue that she melodramatically overstated them. Her father-in-law, George Sexton, the man footing her medical bills, and whose daughter Joan served as the primary custodian of Anne’s children, saw Sexton’s emersion into psychiatry and poetry as overindulgence, an excuse to get out of her wifely duties. In a letter to Dr. Orne, he wrote that Anne was playing them all “…for a bunch of suckers, and that she has no intention of ever assuming her family responsibilities….It appears to me that we all, you, her husband and I, should now get tough with her.”

Kayo, her husband, seemed to take his father’s advice, “getting tough” on rare occasion to the point of domestic violence.

In the end, you’ll note that Sexton chose to live--at least for a time longer. At the same time, it’s clear that she constantly weighed the price of living against the freedom of death until the latter finally won out.

___________________

*While she would eventually take a poetry class taught by former Poet Laureate Robert Lowell at Boston College, she never matriculated.

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Tuesday, July 12, 2011

A Real Love for Big Cheats: The Chameleon’s Evil Twin

Recounting the complete psychiatric history of Anne Sexton would require verbiage far beyond that of a blog post, or series for that matter.  And it would be exceedingly tedious.  Dr. Diane Middlebrook’s Anne Sexton:  A Biography does a decent job giving the play-by-play of suicide attempts, the near-suicide attempts, the hospitalizations, the medications, and the psychiatrists she came to know both inside of therapy and out. 

Perhaps it would be more helpful here to recount some of the psychological themes that developed both inside and outside these therapy session.   These shine light specifically on Sexton’s relationship with Dr. Martin Orne, which extended far beyond his role as her official shrink.


Theme One--Suggestibility

One of the things that Dr. Orne first mentions about Sexton was the diagnoses previous doctors had given her.  Basically, they were all the same:  one flavor of schizophrenia or another.  Orne too initially saw her as typically schizophrenic until he discovered something that changed his entire attitude about Sexton.  He wrote in the Foreword of Anne Sexton:
As I began to get to know Anne, I realized that she was showing ideation that one might expect in a patient with a thought disorder.  Fortunately, she happened to mention that she was spending a good deal of time with two patients who suffered from a schizophrenic disorder, and thus I became aware of her tendency to take on symptoms that were like those of the people with whom she was currently interacting.
After several weeks of working with Sexton, Dr. Orne dismissed schizophrenia diagnosis.  Instead, he regarded her as highly suggestible, and immediately secured her release from the hospital lest she fall under the influence of truly psychotic patients.  As often as he could, he treated her on an outpatient basis.       

During her life it would be difficult to say how this hyper-suggestibility manifest itself, especially in a figure so iconoclastic as Anne Sexton, a woman seemingly almost infatuated with her own individualism.  However, there were times she complained about a suffering a certain kind of loneliness, even in her work:
I have gone out, a possessed witch,
haunting the black air, braver at night;
dreaming evil, I have done my hitch
over the plain houses, light by light:
lonely thing, twelve-fingered, out of mind.
A woman like that is not a woman, quite.
I have been her kind. [From “Her Kind”]
Hyper-suggestibility would imply that Sexton had almost a desperate longing to fit in, much like the eponymous character in the movie Zelig.  In her sessions, she depicts herself as someone trying to live according to the mandatory stereotype of the 1950s normal, suburban, middle-class housewife.  But try as she might, she can’t keep up the charade very long before completely ‘losing it.“  Of course, losing it meant another trip to the hospital.  She sometimes talked about not being a “real” woman--from her inability to care for her kids to questions about her own sexual orientation, to wondering if her literary ambitions were, for a lack of a better term, ladylike.

In this we can imagine that Sexton had a desire to blend in.  I find it curious that the only place where Dr. Orne can confirm her fitting in is with schizophrenics.  On the other hand, this might also help explain her development as a poet.  She hooked up with some pretty heady and erudite people, among them Maxine Kumin, who had two Masters by the time she met Anne.  Maybe fitting in with that crowd helped to refine a raw talent. 

Then again, that’s sort of the purpose of workshops whether the attendee is highly suggestible or downright obstinate.


Theme Two: Doppelgängers
Inside many of us
is a small old man
who wants to get out.
No bigger than a two-year-old
whom you'd call lamb chop
yet this one is old and malformed.
His head is okay
but the rest of him wasn't Sanforized?
He is a monster of despair.
He is all decay.
He speaks up as tiny as an earphone
with Truman's asexual voice:
I am your dwarf.
I am the enemy within.
I am the boss of your dreams.
No. I am not the law in your mind,
the grandfather of watchfulness.
I am the law of your members,
the kindred of blackness and impulse.
See. Your hand shakes.
It is not palsy or booze.
It is your Doppelganger
trying to get out.
Beware . . . Beware . . .
--Anne Sexton, from “Rumpelstiltskin
In therapy and out, Sexton seemed to profess a belief that every individual consisted of at least two different people.  There’s the person themselves, of course.  Then there’s an other self, an archetypal soul that might center on one body, but encompass one or several.  In the poem “Rumpelstiltskin,” for example, she references shaking hands as a symptom of a hidden self emerging. 

Sexton’s hands did in fact shake at one time.  Of course, her tremors probably had more to do with a side effect of an antipsychotic medication prescribed to her, specifically chlorpromazine.*  Nevertheless, the fact that she would see the trembling in this particular way, as if someone else were trying to get out, becomes especially interesting for two reasons.  First of all, since Dr. Orne dismissed schizophrenia as a potential diagnosis, then an antipsychotic seems a weird drug to administer.  True, the drug's also used in the treatment of migraines, opiate withdrawal, severe itching, and cholera.  It’s also been used as a sleep aid for insomnia, and that would seem to be why she received it.**  Still, there were other sleep remedies available at this time, some of them over-the counter.  Given that one of the side effects of the drug is potential memory loss, one would have to wonder why she received this drug in the first place, and whether or not her brief usage of it resulted in any long-term ill effects.

A second reason to look at that passage is that because of Dr. Orne’s 1991 disclosure of Sexton’s sessions we know that during the summer and fall of 1957, Anne manifest a second personality.  Calling herself Elizabeth Harvey (the name of Sexton’s paternal grandmother), the second personality began typing unsigned letters to Orne, explaining that Anne was unaware of her existence.  Moreover, she typed them in the dark so that if Anne did get suspicious or remembered something she still couldn’t read what was in the letters.*** The Elizabeth personality eventually receded after Dr. Orne made the decision not to acknowledge her existence anymore. 

Sexton (as Elizabeth) made an early and conscious connection between the split of her personality and the Capgras Syndrome delusions of her beloved aunt Nana.  In one typed-in-the-dark missive, she wrote:
[Anne] thought of me as a brother that died--she used to think about him all the time there wasn’t really any brother--but she liked to pretend about him--I’m not so different from her but I would tell you what she doesn’t dare think--She acts her life away….I am part of her sometimes but she is not part of me…Nana knew I was not Anne….If you give her enough time to get dissociated enough she will be willing….I know a lot.

What Sexton (as Elizabeth) is referring to here is a pretend sibling that she fantasized about at the age of five.  Unlike the other grownups, Nana indulged the fantasy.  Because of the alcoholism and aloofness of her mom and dad, Sexton found in her aunt a parental confidante, an irreplaceable figure that at times during her life she had to replace.  Consequently, just as Sexton had this eternal soul of Elizabeth inside her, she could just as easily see the spirit of Nana in others.  Thus, a lot of people began to play the role of auntie in her life, among them Kayo Dr. Orne, her father-in-law George Sexton, her mother-in-law Billie Sexton (who began to refer to herself as “Nana”), Dr. Forked Tongue, and Dr. Anne Wilder, a psychiatrist friend whom she didn’t see professionally.

_________________________
*Chlorpromazine sold under the brand name Largactil in most places, and as Thorazine in the United States.

**Dr. Diane Middlebrook mentions that Dr. Martha Brunner-Orne would occasionally pinch-hit for her son when the latter wasn’t available.  During the early 1960s, the two seem to have had some disagreement over sleep medications, so I’m not certain if he prescribed it or she did.  Whatever the case, Sexton found it difficult to write under the effects of Thorazine, and eventually discontinued its use.

***While he took the emergence of a second personality seriously, Dr. Orne never knew for sure whether or not she was joking about the typed letters in the dark.

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Thursday, July 07, 2011

A Real Love for Big Cheats: Controversial Ethics

The end of the affair is always death.
She's my workshop. Slippery eye,
out of the tribe of myself my breath
finds you gone. I horrify
those who stand by. I am fed.
At night, alone, I marry the bed.


Finger to finger, now she's mine.
She's not too far. She's my encounter.
I beat her like a bell. I recline
in the bower where you used to mount her.
You borrowed me on the flowered spread.
At night, alone, I marry the bed. . . .
--Anne Sexton, from “The Ballad of the Lonely Masturbator

We don’t have to speculate about the bulk of went on during Anne Sexton’s treatment by Dr. Martin Orne.  Orne, with permission from Anne’s daughter Linda Gray Sexton, allowed biographer Dr. Diane Middlebrook to review some 300 or so audiotapes of their sessions.  Dr. Middlebrook had already penned a draft of Sexton’s biography, but rewrote it from virtually scratch after receiving the tapes. She also interviewed Orne.  Moreover, he wrote the bio’s foreword.  In it, he gave extensive details about the nature of her problems, what they discussed, and his treatment of her.

Usually, shrinks don’t talk about patients, even dead ones, except perhaps in consultation with other doctors.  Much less do they write about them, or publish the minutes of sessions.  Doctor-patient confidentiality is legally recognized in the United States and elsewhere as grounds to keep personal information out of the public record.  This allows us to discuss our most secret problems and feelings with an assurance of privacy, a necessary component of the therapeutic process.

Dr. Orne could offer no written or audiotaped statement from Sexton that she wanted him to give extremely private information about her to the public.  So one could regard his dissemination of this material as unethical.  Orne defended this disclosure by declaring that Sexton herself would have wanted it.  He cited her actions at Glenside Hospital and Westwood Lodge--her compulsion to help other patients, her desire to ease their suffering--as evidence that she would want her dirty laundry aired to give some solace to people like her.  He also said that he had a verbal agreement with Sexton to do with the tapes whatever he thought was best. 

Many of Sexton’s friends agreed with Dr. Orne’s actions.  To hear them tell it, Sexton had already divulged much of the most secretive parts of herself in her poetry.  As the poem quoted above would indicate, she wasn’t exactly a private person to begin with.  In a foreword to Sexton’s Complete Poems, Maxine Kumin, one of her closest friends, wrote,  “She wrote openly about menstruation, abortion, masturbation, incest, adultery, and drug addiction at a time when the proprieties embraced none of these as proper topics for poetry.”

Newsweek quoted Linda Gray Sexton as saying, “I sometimes wonder if Mother is angry with me [for giving public access to her psychotherapy tapes]…She might have preferred to be seen as a tragic victim. My feeling was: ‘Look, Mom, you wrote about this stuff. You lived it in public. How could I cover it up?’”*

And with respect to psychoanalysis, friend and fellow poet Charles K. Williams told Middlebrook that he was “…surprised by how much she would talk about her therapy when our relationship was not very intimate. But then, it wasn't a very intimate subject to her.” 

In short, it would seem that Sexton was a woman without secrets.

Dr. Orne faced severe criticism from psychiatric and literary circles over his disclosure of Sexton’s private materials when the book came out in 1991.  He expressed surprise and dismay at receiving any criticism to Pennsylvania Gazette reporter Samuel Hughes, musing,  “You know, it isn’t something which under normal circumstances would bother me so.  But it is a peculiar situation.”

The “peculiar situation” prompted those supporting the shrink to take a somewhat defensive posture.  Kumin scoffed at his critics for being hypocritical and “pietistic” telling Hughes, “Those same doctors would never have taken on a patient as demanding as Anne. They just want nice, mannerly depressives.”

Dr. Orne himself, while trying not too much as if he’s tooting his own horn, agreed with Kumin, telling Hughes:
I don't know.  I am not one of those psychiatrists who makes diagnoses without knowing the patient. Some of my colleagues did, unfortunately….

I had a temper, and I lost it with her more than once. I learned from her that it didn't matter what mistakes I made -- only what I could do to help her.

In a sense, the difference was that when the third psychiatrist got angry with her, she -- the psychiatrist -- dropped her. I got angry, but I got over it, and I continued to work with her. That was what counted.

Dr. Orne and Dr. Middlebrook also defended the release of the materials because of their historical, literary and clinical importance.  As Dr. Orne explained, “I felt that the book would be a way of showing the public what psychotherapy can do.”  Dr. Middlebrook pointed to the (literally) thousands of letters from readers who totally identified with her, as if she had become some kind of “voice for the mentally ill.”  Because of the importance of mental illness and psychotherapy in Sexton’s work, both Middlebrook and Orne agreed that the latter didn’t have a very good “feeling” for the person of Anne was until hearing the tapes.  Thus, in order to understand Sexton’s approach to literature she had to understand the main causal factor of it, which both Drs. Middlebrook and Orne credit as psychoanalysis.  Moreover, other shrinks have revealed secret information about their famous former patients (e.g., Jackson Pollack) to biographers.

In time, the voice of the critics would dim.  Nevertheless, one can see their concerns as quite valid.  Dr. Carola Eisenberg (Harvard Medical School) summed up the critics’ objection to the release of Sexton’s material in a paper published by the New England Journal of Medicine:
If Sexton had ever explicitly given permission for the release of this material to her biographer, I would not protest, even though I might well question her judgment. That permission was never given, however; Orne would not withhold such news from us if he had it. He infers Sexton's acquiescence in the release of the tapes from her willingness to have him use them in therapeutic and didactic settings. I disagree; the two situations are not comparable. Sharing therapeutic material with students or other patients, when permission has been given, lifts the curtain of confidentiality only partially and briefly. It is understood by the participants that neither students nor patients will talk with others about the material. In contrast, once published, these privileged communications are open to the public at large without controls on the way they are used, understood, or gossiped about. Furthermore, they are available to those who find themselves in the book, and this may be extremely wounding.
The therapeutic contract with physicians--and with psychiatrists in particular--is based on confidentiality.  What the patient says belongs to the patient, not to the doctor. Its disposition is the patient's prerogative. The full confidence that such is and will remain the case is what allows patients to discuss their most intimate concerns, matters they cannot share with family or friends. Once patients begin to doubt the fidelity of therapists, the context for effective treatment is destroyed….Anne Sexton is dead and beyond harm. The legions of other patients who will learn of Dr. Orne's action are not, and erosion of trust in the profession is irreversible....

It is only the patient who could speak for herself, but Anne Sexton can no longer do so. Precisely for that reason, her silence on the matter should have been respected.

In a 15 July 1991 New York Times article, reporter Alessandra Stanley quoted Columbia University Psychiatry Professor Dr. William Gaylin as saying, “Doctors have no obligation to history and certainly should not act as a research assistant to a biographer.”  To him, Dr. Orne’s actions were a “betrayal” of psychotherapy, which can only exist if openness is protected by the promise that nothing said in session, leaves the session without the patient’s explicit consent.

Even if one acknowledges Sexton’s disregard for her own privacy, then he or she must still question whether or not that gives us license to disrespect that privacy.  If, for example, someone disrobes in front of an open window, it doesn’t necessarily follow that we have the moral right to stand outside his or her house and gawk.  But even more important, patients don’t just talk about themselves in therapy, but about all the people in their lives.  Thus, it was not just Sexton’s privacy at stake, but that of all those close to her.  Drs. Orne and Middlebrook got explicit consent from only a handful of the people involved with Sexton’s inner orbit, among them her daughter Linda and her friend Maxine Kumin.  Other relatives had severe misgivings about the disclosures, among them Sexton’s nieces, Lisa Taylor Tompson and Mary Gray Ford.  In a letter to the Times, they wrote that the Middlebrook bio contained a number of unchallenged false and salacious allegations made by Sexton in these tapes.  These accusations, originally made in the privacy of therapy, tarnished the reputation of good and innocent people, and consequently caused great harm within their family.** 

By contrast, Ted Hughes, Sylvia Plath’s widower, destroyed the poet’s most sensitive papers in order to keep them out of the hands of biographers and protect the privacy of their children (and probably himself). 

Stanley also quoted Dr. Jeremy Lazarus, chairman of the Ethics Committee of the American Psychiatric Association (APA) as saying, “A patient’s right to confidentiality survives death.  Our view is that only the patient can give that release.  What the family wants does not matter a whit.”  To some extent, this brings up the possibility that the family might have its own animus against the deceased, and thus there could be some conflict of interest.  In the case of Linda Sexton, we will see in future posts that she did have a particular axe to sharpen in the revelations that nieces Tompson and Ford would call inaccurate and “sensationalistic.” Lazarus went so far as to later write in a piece for Clinical Psychology News that Orne’s action merited at the very least an investigation by the Ethics Committee.  Lazarus later backed off that position, and no one ever investigated Dr. Orne for any ethical breech.

As it would turn out, the ethics controversy died because Dr. Orne's support among his colleagues and literary critics overshadowed the concerns of protesters.  The tenor of much of this support seemed fairly consistent, with an acknowledgement of Dr. Orne’s dedication to Sexton as a clinician; followed by the affirmation that shrinks should never, ever give out personal information about a patient, even after death; followed by "except in this case," or words along those lines.  Dr. Alan Stone, a professor of law (Harvard Law School) and psychiatry (Harvard Medical School) went so far as to characterize client patient confidentiality as not an ethic, but merely a tradition.  As he said to Samuel Hughes:
There isn't any doubt that Dr. Orne has crossed a boundary that no psychiatrist that I know of has ever crossed before, and because ethics is so entangled with tradition, it immediately seemed that Dr. Orne had done something obviously and clearly unethical. ... The vehemence is a direct result of the break with traditional practice. Any radical break with traditional practice is seen as unethical. But in fact, the whole last 20 years of medical ethics has been devoted to giving patients more autonomy and more control vis-a-vis their doctor. Twenty years ago, doctors wouldn't even let patients look at their own medical records, on the notion that we knew that it wasn't in their best interest. Now, it's quite clear that the patient has the right to look at their own records. Therefore, Anne Sexton's wishes in this matter are really crucial. And Dr. Orne claims that she gave him permission to use these tapes. My view is that if you believe Dr. Orne, then what he did was a judgment call -- but, I think, ethical.

You’ll note that Dr. Stone’s whole digression into the history of medical ethics over the previous twenty years had no bearing whatsoever on the question of the matter here.  This statement and others like it therefore read more like post facto apologia.  Most important, his statement, “If you believe Dr. Orne….” shouldn’t be tossed aside lightly.  After all, Dr. Orne’s made previous appearances on The X-Spot precisely because of his involvement in some shady operations with a lot of shady characters.  Moreover, he was less than honest about his other activities during the time he treated Sexton, only coming clean when clear-cut documentary evidence contradicted him.  Although it makes sense that Sexton might have given him permission anyway due to her exhibitionistic nature, we still only have his word that she gave her consent.  And I, for one, wouldn’t buy a used car from the man. 

And that’s important for another reason.  Dr. Middlebrook’s biography not only takes an uncritically laudatory approach to the role of psychotherapy in developing Sexton as a poet,*** but also heaps uncritical praise upon Dr. Orne himself--an element that receives notice even from Orne’s supporters.  As literary critic Sandy McClatchy told Stanley, “There is something a little sleazy about the way he has put himself forward as her [Sexton’s] Pygmalion.”

In fact, Dr. Orne’s presence in the Middlebrook bio is quite profound.  Not only did he write the foreword, but Dr. Middlebrook quoted him extensively, and at length.  Indeed, the book goes to great lengths to establish Dr. Orne’s integrity.

And considering what else was taking place in his professional life during this time, in conjunction with what’s contained on those tapes, I can’t help wondering….

Wondering…..

Is there a bit of snow job going on in Dr. Middlebrook’s biography?  More to the point, was there a connection between Orne‘s night gig, and his treatment of Anne Sexton?  
_________________
* In a later letter written for the New York Times, Linda Sexton went on to explain that the tapes "…would have been mere objects of prurience had they not revealed the roots of her poetic style-the unconscious associative process employed in analysis, which was to become the trademark of her poetry. And, perhaps unlike therapy tapes from any other author, these were almost uniquely relevant to any searching analysis of her poetry….”

**On an interesting note, Sexton’s elder sister, Blanche Taylor passed away several days after my research on this series began in earnest.  She was the mother of Tompson and Ford, and a prominent person in her own right.  Curiously, many of the obituaries I found of her make no mention of her relationship to Sexton.  That’s not to say that the Middlebrook bio might have caused enough consternation within the Harvey family to make associations with the poet uncomfortable or awkward, despite Sexton’s accomplishments and fame.  But I must admit, the thought crossed my mind.

 ***See Charles Gramlich’s comment to the previous post.

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Sunday, July 03, 2011

A Real Love for Big Cheats: The Road to Psychotherapy

Anne Sexton was the youngest of three daughters born to Ralph and Mary Gray Harvey, who named her after her great-aunt, Anna Ladd Dingley. Both parents came from established, well-heeled families, with some of her relatives in the publishing business. Despite the economic woes of the 1930s, the Harvey family prospered during the Depression.  They lived in a fairly spacious house staffed with servants, and vacationed regularly. They entertained often, and were society fixtures.

Anne’s family might have seemed glamorous and solid to the neighbors. But cracks undermined the pristine surface. Their troubles ironically surfaced after the Depression. Plagued by increasingly severe alcoholism, Ralph’s behavior grew more and more unpredictable. As Sexton would later explain, he’d be his usual happy loving self one minute, and then “He would just suddenly become very mean, as if he hated the world.” Her mother also drank, and her moods shifted erratically too.

Anne often found solace in the company of her great-aunt Anna, or as she called her, ‘Nana.’ The two were quite close until around 1940 when Anne, then thirteen, discovered boys. Later on, they had a falling out when, stricken with illness, Nana accused Sexton of being an imposter of her beloved niece.*

Anne dated regularly, but only had one steady boyfriend, Jack McCarthy, during most of her teenage years. He dumped her, and she wound up dating Alfred (called Kayo by friends) Sexton two years later.

Things seemed to go well for Anne and Kayo during courtship. But marriage changed everything. Anne’s wondering eye became a major problem.   A serious extramarital flirtation began with a man she and her husband met on their honeymoon.  When it threatened to become a full-blown consummated affair, Sexton’s mother intervened, and sent her to Dr. Martha Brunner-Orne, the psychiatrist who had previously treated her father for alcoholism.

Dr. Brunner-Orne wasn’t just any run-of-the-mill shrink. She was a former research fellow at the Mayo Clinic, on the staff of Wellesley College, and Director of Westwood Lodge. Her assessment was that Anne had “…difficulty controlling her desire for romance and adventure.”

Ya think? I know a few couples who are only interested in each other after years of marriage, and I know many more connubial veterans for whom the thought of adultery has either crossed their minds, or crossed their reality. I’ve never known a newlywed to chase someone she met just days after tying the knot.

In 1951, Kayo entered military service. The Army shipped him off to Korea. Anne, lonely and bored, could no longer hold back, and began a series of affairs that lasted until his discharge, whereupon they decided to have a family. She gave birth to her elder daughter, Linda Gray Sexton, in 1953. No problems. But two years later, after her second pregnancy with Joyce Ladd Sexton (named after Nana), she went into post-partum depression, which quickly grew worse. As Diane Middleton wrote:
Sexton’s psychological state took a definitive turn for the worse five months after entering treatment, when she developed a morbid dread of being alone with her babies…

Increasingly, Sexton became prone to episodes of blinding rage in which she would seize Linda and begin choking or slapping her…She felt she could not control these outburst, and she began to be afraid that she would kill her children.
On top of this, Sexton felt suicidal. When she finally confessed her feelings to Kayo, he sent the kids away to live with relatives, and took her back to the same doctor she saw in 1955.

Understanding the urgency to treat Sexton, Dr. Brunner-Orne checked her into the hospital.** She couldn’t tend to Anne right away, however, because she had already booked her vacation. So she handed the case over to her son, a young psychiatrist only a year Sexton‘s senior.

Dr. Brunner-Orne’s son, Dr. Martin T. Orne, would wind up treating Sexton exclusively over the next eight years, and in consultation with other physicians until 1973.

____________________________
*
This particular delusion, called Capgras Syndrome, seems to occur under varying circumstances, from schizophrenia to brain injury to stroke. It’s characterized by the sufferer’s belief that an imposter has replaced someone close to them.

**Sources vary as to whether she first checked into Glenside Hospital initially and then transferred to Westwood Lodge, or went straight to Westwood.

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