The Poet's Art Mined the Patient's Anguish

To the Editor:

Your account of my use in a biography of Anne Sexton of audiotapes that recorded the poet's psychotherapy with Dr. Martin Orne (front page, July 15) has unfortunately created a false impression of the extent and nature of Dr. Orne's work with me. I would like to supply some details.

For the first five years of my research, 1980-85, Dr. Orne did not acknowledge my requests for an interview. In 1985 an introduction was arranged by a colleague in the Stanford University psychology department, who had heard me present work in progress and knew of the Sexton estate's cooperation on access to Sexton's medical records, on which she had drawn heavily in writing the play "Mercy Street."

My colleague proposed that Dr. Orne assist me in reporting information already in my possession. Dr. Orne agreed. We met in August 1985, after I had drafted an account of Sexton's treatment based on materials to which the family had given me access. These included hospital records; the personal journals in which Sexton had kept notes on her 1961-64 therapy tapes, and transcripts I had made of four tapes that remained among her papers at her death in 1974. These materials had been placed by the Sexton estate at the Harry Ransom Humanities Center at the University of Texas in Austin, under restriction.

At this interview Dr. Orne told me that Sexton had left most of the tapes in his possession for whatever use they might prove to be to others. (Therapy, she had told him, "is one of the minor arts.") However, it was not until October 1986, after discussions establishing procedures for their use, that Dr. Orne sent me the tapes and clinical notes on which I based my discussion of Sexton's treatment and its part in her development.

The estate and the psychiatrist granted me access to these medical records because of the many ways treatment promoted Anne Sexton's evolution as a writer; the extensive use she made of psychotherapy as a theme and inspiration, and her own indifference toward privacy.

Ethicists consulted for your article had to respond without having seen my book, which has not yet been published, in judging Dr. Orne's culpability for violating confidentiality. Those of us responsible for deciding what should go into the book--heirs, doctor, publisher, author--were acutely aware of the moral complexities. Yet it seemed to us that the tapes provided a historical record of the processes by which a human being had survived a mental illness by turning her treatment into an education in the service of art.

For me listening to the tapes provided immeasurably valuable insight into the person Sexton had been during the most important period of her creative life. I could not talk to her, but on the tapes she spoke 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 and mother into prize-winning poet. The tapes made me privy not only to anguish but also to thousands of homely particulars that make up an actual life. This was surely the rarest privilege ever conferred on a biographer, and I am deeply grateful for it to both Linda Sexton and Dr. Orne.

DIANE MIDDLEBROOK
London, July 20, 1991

Trust Is at Stake

To the Editor:

Dr. Martin T. Orne, in explaining his making available for publication privileged material and tapes of a patient, the poet Arme Sexton (from page, July 15), claims that he "was often more concerned about her privacy than she was." While he might also be correct in presuming Sexton's implied approval for his action while she was alive, I feel strongly that he was wrong in violating the contract of confidentiality that always exists between psychotherapist and patient.

The question is not if Anne Sexton's wishes were correctly perceived, but whether or not a psychiatrist is ever justified in disregarding confidentiality without the patient's explicit, freely given permission. If Dr. Orne's action were condoned, no patient would have any basis for trusting any psychiatrist, since the decision to disclose could be made unilaterally if it furthered the goals of scholarship or any other ostensibly worthwhile purpose. No scholarly insight can be worth the sacrifice of the integrity so essential to the psychotherapeutic endeavor.

JOSEF H. WEISSBERG, M.D.
President, American Academy of Psychoanalysis
New York, July 16, 1991

Nothing Hidden

To the Editor:

As someone intimately familiar with the process by which Diane Middlebrook wrote her forthcoming biography of my mother-in-law, Anne Sexton, I was surprised by "'Betrayed: The Poet and the Public" (editorial, July 20).

You criticize the poet's psychiatrist and her literary executor for having given permission for Ms. Middlebrook to listen to and quote from audiotapes of Anne Sexton's psychiatric sessions. You state: "Anne Sexton likely assumed that the relationship between psychiatrist and patient was as confidential as that between priest and penitent." True enough; but to Anne Sexton, who made a career of what quickly and quite aptly became known as confessional poetry, neither the doctor-patient relationship, the priest-penitent relationship nor anything else of literary value was in the slightest way confidential.

In the 1950's, while suburban housewives who had suffered nervous breakdowns did their utmost to conceal them, Anne Sexton wrote about her psychiatric problems and hospitalizations publicly. While married. she wrote openly of her love affairs-- regardless of the impact on her husband or family.

Late in her--life, when she assembled her archives and appointed her daughter Linda Gray Sexton literary executor, Anne Sexton clearly marked the items she wanted never to be published; Linda abided by those wishes. Audiotapes from psychiatric sessions with Dr. Orne in the poet's possession, as well as her detailed notes from hundreds of other such tapes, were not so marked; they were in a category that allowed Linda to use her best judgment.

Further, no "kiss and tell" disclosures in the tapes were used in the biography; it uses the tapes to explicate the poetry and its creation.

Your July 15 front-page article quoted the poet's daughters and Maxine Kumin, her best friend and closest literary collaborator, as unanimous that the poet would have approved of the way the tapes were used in the biography. Further, Dr. Orne was not alone in making the poet's psychiatric record available to the biographer. After having received a request from Linda, every psychiatric institution in which Anne Sexton was hospi- talized granted access to the medical record. One institution requested a court ruling, and the court obliged.

You say Anne Sexton's psychiatrist and literary executor betrayed her by giving Ms. Middlebrook access to the tapes. But, given Anne Sexton's clear instructions to her literary executor, and the way she used her most inti- mate experiences for the sake of her art, it would have been a betrayal by Linda not to allow the tapes to be used in the biography.

JOHN G. FREUND
New York, July 22, 1991