Psychiatrist and Biographer Differ Over Anne Sexton's Suicide. Was It

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Psychiatrist and Biographer Differ over Ame Sexton’s Suicide. Was It Preventable or Inevitable?

Number 11 March 16.1992

ABSTRACT Anne Sexton; A Biography by Diane Middlebrook is discussed in terms of the role Martin T. Orrre played in its creation, particular y the controversial release of the ps ychiatrist’s therapy tapes with the poet. Ome’s Foreword to the biography, in which he expresses the view that Sexton’s suicide was preventable, is reprinted. Middlebmak srgues that Sexton had reached a point in her life where the act was inevitable,

When I fmt learned that Diane Middle- observers like Albert Rothenberg15 do not brook was writing a biography of Anne Sex- believe that depression and poetic creativity ton,l I was fascinated by the coincidence of are necessarilyy linked. The fact that depres- several isolated events. In the first place, I sion is largely undiagnosed in the general had originally met Diane through her hus- population may give the impression that it band, chemist Carl Djerassi. Secondly, I had is more prevalent among highly creative learned to respect her competence as a hu- people. manities scholar and was aware of her infht- I must confess that before encountering ence in the creation of Djerassi’s Cantor’s Middlebrook’s biography, I had not read Dilemma,2 a novel about a scientist winning Anne Sexton’s poetry. Of course, like many the Nobel Prize. others, I had heard about her work and what Another coincidence was my acquaintance she symbolized to her many admirers. with Martin T. Ome. I ftrst met him when I Perhaps the most controversird aspect of was seeking an expert on hypnosis, the sub- Middlebrook’s biography is the role that ject of a Current Contents@ (CC’) essay3 Martin Ome played in its creation. He has and a topic discussed peripherally in other been widely criticized, perhaps unfairly, and essays.$b ~ter I met Martin at Sevemi so- rdso supported for having agreed to release cird functions. And still later, we met at an the tapes to the biographer of his therapeu- annual get-together of the Unit for Experi- tic sessions with Sexton over a three-and-a- mental Psychiatry at The institute of Penn- haif-year period. sylvania Hospital. Sexton kept chronological therapy note- Last but not least, suicide is unfortunately books that detailed each session of her treat- a subject of which I have fiisthand knowl- ment with Ome. Sexton’s estate had pro- edge. My daughter Thea committed suicide vided these to the biographer years before more than 10 years ago. Concomitantly, the the release of the tapes. However it is one subject of depression, inseparable from sui- thing to read about the therapy process and cide, has been discussed in CC in many dif- quite another to actually be able to hear the ferent contexts.7-12Clearly, there is a wide- work of therapy-both the anguish as well spread belief that it is an affliction common as the triumphs. There were no new facts among creative people.13,14However, some brought out from the tapes, but listening to

35 them allowed the biographer to live with disclosure of information provided by a pa- Sexton and Ome for 311 hours.’6 The im- tient in confidence, but Sexton was a pa- pact of actually being with Sexton was suf- tient who wrote confessional poetry about ficient to change Middlebrook’s feelings her mental illness and who requested that about her; she said that the person she came details of her therapy on tape be used to to know from the tapes required her to re- help others; thus, the unusual circumstances vise her portrayal of the poet in the final in this case may wamant public disclosure. biography. 17 In his Foreword to the biography, re- A Little About Sexton and Orne printed below, Orne explains some of his reasons for having released the tapes and Anne Sexton committed suicide in 1974 also expresses fundamental disagreement at the age of 45. She went into her garage, with Middlebrook on the question of turned on the ignition to her car, and died whether Sexton’s suicide could have been by carbon monoxide poisoning. Her life as prevented. Middlebrook argues that Sex- a poet and mother had been tumultuous. ton had reached a point in her life where Tragically, over the years she had become her desperate act was inevitable. While by addicted to drugs and alcohol. Neverthe- 1974 suicide might have been inevitable, less, she was able to maintain the disci- Ome takes the position that proper therapy pline required of an artist and teacher al- in the preceding decade would have pre- most to the end. vented her suicide. Sexton was born in 1928. She was the These matters have been widely dis- thiid of three daughters to Ralph and Mary cussed, even on the front page of The New Gray Staples Harvey, described by YorkTimes18and in numerous other publi- Middlebrook in the biography as being “like cations. If a measure of a book’s success is characters out of a Scott Fitzgerald novel, the number of reviews and news stones it children of the Roaring Twenties: good- generates, then this publication is a block- Iooking, well-to-do, party-loving, and self- buster. indulgent.’” (P. 4) 1 will not attempt to review all the argu- The family called Wellesley, Massachu- ments for and against the general subject of setts, home. At age 20, Anne married public release of information about patients. Alfred Muller Sexton II, nicknamed Kayo I observe that Middlebrook indicates in her after the character in the comic strip Moon preface “Everything I have learned about Mullins. They had two children, Linda and her [Sexton] suggests that she would not Joy. Anne had divorced Kayo shortly be- have held back from the archive of her fore she committed suicide. manuscripts and private papers the full col- After her second daughter, Joy, was born, lection of tapes.”[ (p. xxii) Sexton, suffering from severe depression, Orne had Sexton’s explicit verbal per- sought the help of a psychiatrist who had mission and request in 1964 to use the treated her briefly once before. This was tapes in any way that could help others. Martha Brunner-Ome, the mother of Mar- Middlebrook and Ome believe that if Sex- tin Ome. She would recommend her son as ton were alive today she would still have a therapist, and he treated Sexton for some enthusiastically approved publication of eight years, playing a pivotal role in her the biography. Since the biographer had life. . the encouragement of Sexton’s daughter Martin Orne was 29 when he became and literary executor, as well as other fam- Anne’s psychiatrist. At that time, he was ily members and friends, the exception to an MD from Tufts University and was the inviolate rule of confidentiality may completing his PhD in psychology at be justified. Harvard, where he had earned his under- Understandably, no ethical physician graduate degree. He also was a resident in would want to be seen as encouraging the psychiatry at the Massachusetts Mental 36 I

Martin Ome Diane Mia’dlebrook

Health Center. Today he is professor of could pursue-prostitution. Given her diffi- psychiatry at the University of Pennsyl- culty in remembering significant emotional vania Medical School, director of the Unit interactions in therapy, a new therapeutic of Experimental Psychiatry at The Insti- technique was devised which included the tute of Pennsylvania Hospital. and adjunct taping of therapy sessions, Sexton’s writing professor of psychology at the University up of everything she remembered from the of Pennsylvania. session, and then listening to the tape the Ome has written extensively in his field next day and correcting her initird report to and served on the board of many psychiat- reflect what actually transpired during the ric journals, He is a Fulbright scholar and session. In this way, over time, her memory has received other awards, particularly for recall was strengthened. his work in hypnosis. His most-cited paper, Ome’s encouragement to write evidentiy “On the Social Psychology of the Psycho proved to be just what she needed. Within logical Experiment, With Particular Refer- four years of entering therapy, Sexton pub- ence to Demand Characteristics and Their lished her first book of Poetry?l followed Implications,”19published in 1%2 in Amen”- by a second only two years later.22 During cmr Psychologist, had been cited more than this time, she also became a Radcliffe 740 times when Ome wrote his Citation scholar. This, indeed, was an accomplish- Classic@ commentary in 1979.20Since then, ment for a patient of such low self-esteem it has been cited an additional 350 times in whose only schohdy accomplishment be- the Social Sciences Citation Index@. fore therapy was finishing high school. After diagnostic tests in 1956 reveaied While the professional ethics of releas- that Anne Sexton had considerable undevel- ing the therapy tapes turned out to be the oped creative potentird,Orne encouraged her focus of press attention, Middlebrook had as part of therapy to develop herself as a anticipated a greater reaction to the revela- poet and writer. But Sexton had very low I tion that Sexton had had a prolonged love self-esteem. At the time of entering therapy, affair with the psychiatrist who treated her she indicated only one possible talent she I after Ome moved to Philadelphia. 37 Mkhllebrook Comments ;haracter, toward whom the stance of the on the Biography’s Reception mthor is that of investigative journalist or malyst. I wanted to write s narrative---+ I asked Middlebrook to comment on the ;tory-that would foreground Sexton’s re- reception of the Sexton biography and auy sourcefulness in accommodating herself to second thoughts she might have on ques- her intractable psychological disabilities. tions raised by readers. That request re- Moreover, I was convinced that she did not sulted in this communication: ierself know the truth status of her own The most provocative questions I have memories, and eventually came to a wise been asked since the book came out center insight about them: that once she had put a on the way I handled Sexton’s recollec- Feeling into words, the words were what tions of a sexual overture from her father she remembered. Sexton’s work explores and of sexual feelings toward her great- the psychodynamics of ordinary family life aunt. Child sexual abuse is a widely dis- by tapping into the fantasies it generates. cussed social issue, and a focus of marry [n my view, it is reductive to insist that she psychotherapies; readers come to the book could only have represented what she had expecting Sexton’s memories of childhood experienced firsthand. Truth to feeling was to be discussed in terms of feminist issues, the hallmark of her work, and this kind of or at least from the perspective of current truth had great power over the imagina- research. As one very disappointed person tions of her readers and listeners, whatever wrote to me, ‘I am an incest survivor. I its sources in her life.” read Anne Sexton: A Biography because I Having earned her PhD from Yale Uni- heard it dealt with incest.’ This person saw versity in 1968, Middlebrook came to the the biography as perpetuating society’s and writing of the Sexton biography with a con- the family’s worst crime against the victim siderable knowledge of her subject. She has of incest: not believing her story. written and edited a number of books on “The attitude of biographers toward in- poetry, and was coeditor of the 1988 Se- cest has become an issue itself in literary lected Poems of Anne Sexton.24 criticism, heightened by the publication of Middlebrook has taught in the English Louise DiSalvo’s study, Virginia Woolf Department at Stanford University since The Impact of Childhood Sexual Abuse on 1966. She also has held positions as direc- Her L#e and Work.23 DiSalvo’s book opens tor of Stanford’s Center for Research on with a one-sentence paragraph: ‘Virginia Women, as associate dean of Undergradu- Woolf was a sexually abused child; she ate Education, and chairperson of the Pro- was an incest survivor.’ All DiSalvo’s rea- gram in Feminist Studies. She was a soning is, of course, deductive: ‘the survi- Guggenheim Fellow in 1988/1989. The bi- vor of incest abuse may... are more ography of Anne Sexton was a finalist for likely,. often...’: for each category of symp- the 1991 National Book Critics’ Circle toms, a match is found in the subject. Her Award for Biography. conclusions abut Woolf are phrased in terms of what must have happened, given ***** what we kuow about symptoms. “Perhaps such a book will someday be My thanks to Pard R. Ryan and Eric written about Anne Sexton, tcm--a good Thurschwell for their help in the prepara- book-but I didn’t want to write it. Such a tion of this introduction. book has a defenseless victim as its central a ]W 1s1 REFERENCES

1. Mfddfebraok D W. Anne Semen: a biography, Boston, MA Houghton Mifflin, 1991.488 p, 2. Djeraasi C. Cantor’s dilemma. New York Daubleday, 1989.230 p. 3. Garffeld E. Taking the hype out of hypnosis and a look at its entrancing usc in pain control. Current Corrrerm (3):3-9, 19 Jamrary 1987. (Reprinted in .Essays ofcrn information scientist: the awards of science and other essays. PhiladelpMa 1S1press, 1989. Vol. 10. p. 14-20,) 4------‘f%e 1984 NAS award for excellence in scientific reviewing E.R. HiJgard recsives sixth award for his work in psychology. Currem Contents (24)3-6, 11 June 1984. (Reprinted irx Ibid,, 1985. Vol. 7. p. 182-5.) 5------AU snrta of warts-separating fact from fiction, Part 2, Treatment, spontaneous regressing, and key publications. Current Contents (10): 3-9,7 March 1988. (Reprinted ix Ibid., 1990. Vol. 11. p, 68-74.) 6------Noninvasive medkinc. Part 1. No more needfes, fear, or pain. Current Contents (41)3- 12,10 October 1988. (Reprinted in: Ibid. p. 325-34.) 7------What dn we krrow about depression? Parts 1-3. Current Conlents ( 19):5- 12, 11 May 1981; (20)5-12, 18 May 1981; (27):5-11,6 July 1981, (Reprinted in: [bid., 1983. Vol. 5. p. lCO-15; 157-63.) 8------Allergies arc nothing to sneer.c at. Part 3. Behavioral marrifestations. Currenr Comenfs (42):3-13, 21 October 1985, (Reprinted in: [bid., 1986, Vol. 8, p. 392-402.) 9------Electroconvrdsive therapy: malignant or maligned? Current Corrrevm (42):5-9, 15 Cktober 1979. (Reprinted in: Ibid, 1981. Vol. 4. p. 294-8.) 10------Should we kick the caffeine habit? Current Conrerm (7):5-9, 18 February 1980. (Reprinted irx Ibid. p.389-93.) 1l.------—. Will a bright mind make its own way? Current Contents (S1 ):5-15, 22 December 1980. (Reprinted in: ibid. p. 713-23,) 12------The Ioneliriess researcher is not so lonely anymore. Currem Contents (5):3-10, 3 February 1986. (Reprinted irx Ibid, 1988, Vol. 9. p, 33-40.) 13. Lieb J & Herafrrrran D. The key to genius. Buffalo, NY: Prometheus, 1988.220 p. 14, Jamiamr K R Maaicdeprr%sive illness, creativity, arrd Ieademhip. (Gcodwin F K & Jamison K R, ed.s.) Manic-depressive illness. New York Oxfod University press, 1950 15. Rotberrberg A. Creativity & rnadnas: newjlnriings and ofd stereotypes. Baltimore, MD Johns Hopkins University Press, 1990. 16. Middlebraok D W. The pcet’s art mined the patient’s anguish. (Later.) Nrw York Times 26 July 1991. p, A26. 17------Spinning straw into gold: a biographer’s story. Stanford June 1991. p. 47-9. 18. Stmrfey A.Poet told afl; therapist provides the record. New York Times 15 July 1991. p. Al; C14. 19. Orne M T. Orr the aociat psychology of the psychological experiment, with particular reference to demand characteristics and their implications. Amer. Psychol. 17:776-83, 1962. 20------Citation Cbrasic. Commentary on Amer. Psychol. 17:776-83, 1962. Current Contentw%cial & Behavioral Sciences 11(13)26, 26 March 1979. [Reprinted in: Contemporary cfa.rsics in the social and behavioral sciences. (Smelaer N J, comp.) PMladelphix 1S1 Press, 1987, p. 56.] 21. sexton A. To bedlam and part way back. Bostnn, MA Houghton Mifflin, 1960.67p. 22------All rrryprerty ones. Boaton, MA Houghton Mifflin, 1962.68p. 23. DSafvo L. Virginia Woolf the impact of chifdhood sexual abuse on her life and work. Boston, MA Beacun Press, 1989. 372p, 24, sexton A.Selected poems ofAnne Sexton. (Middlebraak D & George D, eds.) Bostnn, MA Houghton MiftMn, 1988. 266p,

Foreword to Anne Sexton: A Bwgraphy by D.W. Middlebrook By Dr. Martin T. Orne

I recall clearly my first therapy session recognized that she was truly unable to care with Anne Sexton. Her vivid description for them. In many ways she loved her chil- was poignant with regard to her total in- &en and family dearly, but she simply ability to live the life 8he believed was de- could not cope with the roles required. Al- manded of her. She felt helpless, unable to though she was trying her best to live up to function as a wife or mother, and expressed the 1950s image of the good wife and resentment at having her children taken mother, she found the task completely be- away from her, yet at the same time she yond her.

39 Since I have always believed that it is at -esteem.“l’he]mpetus to go torward wlttr lt least as important to understand a patient’s eventually gave her the strength to follow resources as to determine the amount of up by participating in poetry workshop ses- psychopathology, 1 sought to explore sions. She was able to obtain and use the Anne’s resources and goals. She had mar- necessary criticism and feedback she re- ried early and had barely finished high ceived in these sessions to improve her school. She particularly regretted her lack work in a way that is very unusual early in of formal education, which contributed to an artist’s career. Once Anne was assured her feelings of inadequacy. It is difficult to that she really was able to write poetry, she communicate fully how pervasive Anne’s almost could not stop. Writing poetry be- profound lack of self-worth was and how came the driving force. totally unable she was to think of any posi- Thus began an incredibly rocky but tive abilities or qualities within herself. strengthening period in Anne’s life. Little When I pressed her to think hard about by little, she began to deal with the prac- what she might be able to do, she finally tical problems of correspondence, of sub- revealed that there was only one thing that mission and resubmission, of reviewing she might possibly be capable of doing and rewriting. At last she could connect well—to be a good prostitute and to help with peers and teachers, with whom she men feel sexually powerful. It was clear could for the first time begin to commu- that in her case, goals were not a place to nicate outside the therapy setting. Even start to find positive facets to bolster a sense though Anne was among my first long- to self. term patients, my experience had been, Early in therapy, I focused on Anne’s and still is to this day, that the sicker the developing her skills, suggesting among patient is, the more important it is for the other things that she begin writing about therapist and the patient to work on a task her experiences in order to help other pa- together, so that the patient can develop a tients. This idea struck a responsive chord stronger sense of self from the work ac- in her, and we were able to work on it complished. If the patient can fulIy in- together without her immediately getting volve herself in a task that takes on its so discouraged as to reject it. Developing own meaning in her life outside the the supports for a sense of self that Anne therapy sessions, then resolution of the could appreciate was not easy. It took some other problems we need to deal with in months, but there finally came a time when the sessions can also carry over to her we were able to begin to discuss the possi- world outside. bility of her continuing her education. While Originally, when Anne sought help fol- this was a goal that she was now willing at lowing the birth of her second child, she least to talk about, her fear of strangers left had been diagnosed as having postpartum her unwilling to take the necessary steps to depression. When I first saw her in therapy attend formal courses. At that point, how- in the hospital in August 1956, a year after ever, she herself returned to my original, the birth, her thoughts and behaviors were almost offhand comment, “How about wri- not really consistent with the presumptive ting?” and she began to bring poems to our diagnosis. As I began to get to know Anne, sessions. I realized that she was showing ideation In the beginning, her poems obviously that one might expect in a patient with a needed much additional work, but they were thought disorder. Fortunately, she happened clearly pieces with a compelling communi- to mention that she was spending a good cation and a flair that Anne and I could deal of time with two patients who suf- discuss-a meaningful project on which she fered from a schizophrenic disorder, and could begin to build a foundation. The sheer thus I became aware of her tendency to existence of the task of writing poetry, take on symptoms that were like those of through which she could describe her pain, the people with whom she was currently her confusion, and her observations, pro- interacting. Indeed, because of this ten- vided the basis for a critical sense of self- dency, I was even more careful not to have

40 Anne stay in a hospital setting any longer than was absolutely necessary, lest she adopt new symptoms from other patients, As we continued to work together, it became increasingly evident that in addition to her tendency to absorb symptoms and mannerisms from those who impressed her, Anne’s core problem was that she suffered from a severe difficulty of memory. While to some extent each of us is selective in what we remember, Anne’s selectivityy was extreme in the sense that she literally remembered almost nothing of relevance from one session to the next. In short, for this and other reasons, it was clear that she had a condhion that traditionally was known as hysteria. Anne’s severe memory problem was eventually to lead to an impasse in her therapy. That is, rdthough within an indi- vidual session she was able to work effec- tively during treatment, it emerged over a period of months that each therapy session had the quality of having a beginning, a middle, and an end—which gave both therapist and patient the feeling that somethhg meaningful was being accomplished. Yet, in looking back over the work of the sessions, I gradually realized that each session was a vignette unto itself, with very little progress being made across therapy sessions. In other words, even though Anne was expressing and working with intense Anne Sexton feelings, the therapeutic process somehow failed to move forward in the larger sense. aid to her memory, but performing this task At first I tried to aid Anne’s memory by interfered with the process of treatment. I taking more extensive notes myself, so that then suggested that we audiotape our ses- I could more easily help her recall the im- sions and that it would be her responsibil- portantaspects of the previous sessions in ity to review what had happened in the order to achieve a much-needed feeling of session. It turned out, however, that simply continuity. After several false starts in this listening to the audiotape was by no means endeavor, I rerdized that it was necessary sufficient to break down Anne’s tendency for Anne herself to become the one respon- to develop amnesia for the events of the sible for remembering what we were doing past session. Furthermore, it did not have together. In other words, it was not my role the consequence of making her aware of to take on the responsibility to remember the difference between what she remem- what occurred in our previous sessions, but bered of a session and what actually oc- hers. curred during that session. However, we Together we worked toward evolving a eventually hit upon a viable procedure. procedure to deal with the problem that First we would audiotape the therapy ses- resulted from Anne’s inability to recall what sion, and afterward Anne was asked to had occurred in previous sessions. I tried make extensive notes about everything she to have Anne make extensive notes as an could remember from the session. The next

41 day she would come to the off~ce, and my began to be published, she found that many secretary would put the tape on the recorder troubled individuals sought her guidance and leave her alone to listen to the session. and counsel. Indeed, she took great pride She was asked to note particularly the dis- in being able to help others with similar crepancies between her memories, her notes pain. She spent an inordinate amount of from the previous day, rmd what actually time answering letters from strangers, and happened on the tape. In the beginning, it undoubtedly helped many of them. Al- was necessary for Anne to listen to the au- though she became a professional poet in a diotape twice before she was able to recall remarkably short time, Anne never stopped on her own what we had dealt with during recognizing the importance that her poetry the session. This tedious approach de- might play in the lives of her readers. manded a great deal of Anne, but its con- When Professor Diane Middlebrook re- sequences were profound. For the first time quested an interview to discuss my work in her life, she was able to recall why she with Anne, it was uppermost in my mind had been upset about something someone how important it had been to Anne always had said, or why she had been angry at me, to try to help others, especially in their writ- without knowing the reason. In other wotds, ing. Although I had many misgivings about Anne could really remember and learn discussing any aspects of the therapy, which about her feelings, whereas in the past she extended over eight years, I also realized had been unable to recall more than frag- that Anne herself would have wanted to ments of what occurred-many of which share this process-much as she did in her she recalled incomectly. poetry-so that other patients and thera- The constructive consequences of this pists might learn from it. After much soul- audiotaping, listening, and note-taking pro- searching, and after being assured that cedure for increasing memory and for mak- Anne’s family had given their encourage- ing progress in therapy cannot be overem- ment and approval, I allowed Professor phasized. Though it is fair to say that the Middlebrook to have access to the audio- procedure led to some embarrassing mo- tapes and my therapy file, including the ments for me as the therapist-since Anne early unpublished poems Anne brought to was able to point to errors in my memory therapy. It is in the spirit of helping others of prior sessions—it was a unique experi- that I also offer here a view of what I be- ence for Anne to know more about what lieve contributed to Anne’s untimely death. transpired in her treatment than her thera- There is one aspect of Anne’s life that pist did. In many regards, it made the rela- has not been clarified, that is, her tendency tionship between us far more equal than in to become uncommunicative in a self-in- the past—a true collaboration, in which duced trance, which could last minutes, Anne could discover important insights and hours, or, in a few rare circumstances, even share them with me. Thus, her sense of self days. Typically, the trance episode could had developed to the extent that she could easily be ended by a therapist familiar with attend to her own behavior as well as to the symptom. But in therapy and out, the that of others. Whereas the therapist usu- problem persisted: when Anne was ex- ally holds all the cards, the patient now tremely angry, she was given to entering a could know more about what was happen- trance and becoming unresponsive. Treat- ing in treatment than the therapist did. In- ment helped to decrease these events, but deed, Anne made a major step forward they were never eliminated. Anne also had when she was first able to show me that I a remarkable fascination with death, and it was wrong ! seemed likely that she used some of the By listening to and being able to tolerate trance episodes to play the role of dying, her own pain and anger on the audiotapes, which perhaps helped her not to suicide. and by developing the ability to recall emo- However, when her relationship with sig- tional events that mattered to her, Anne nificant others was dkninished, and if she was gradually able to deal with these emo- was in a period when death seemed attrac- tions in her poetry. Soon after her poetry tive, there was always the danger that she

42 would do the deed rather than play the role. visits to Boston. Although Anne initially Unfortunately, Ame’s relationships with a did extremely well with another therapist, number of significant others, especially her the therapeutic contract became untenable husband, were diminished through a series because of a change in their relationship. of events that began with my move from Unfortunately, this change also undermined Boston to Philadelphia. her crucial relationship with her husband, When I made the decision to leave thereby depriving Anne of what had been a Harvard to come to Pennsylvania to fur- vital interpersonal support. ther develop the Institute for Experimental During thk d]fficult time, Anne contin- Psychiatry, Anne and I had the opportunity ued to see me in treatment on follow-up, to work together for several months before and I was eventually able to help her in the she transferred to another therapist in Bos- difficult process of finding yet another ton. By then she had progressed in treat- therapist. Finally she decided on a female ment in many areas of functioning, though therapist who had been suggested by her she continued to need therapeutic help. At previous therapist. Unfortunately, this new that time she was already a well-known therapist decided she could treat Anne only poeL having published two collections and if Anne stopped seeing me completely, be- having written a play. She was also soon to cause in her view, Anne’s transference re- win the Pulitzer Prize and to be accepted lationship with me would undermine treat- by rhe academic worid. which had become ment. In this way Anne lost yet another a major goal for her. Equally important was support, which further eroded her ability to the fact that by this time Anne’s relation- withstand a serious therapeutic setback. Not ship with her husband, Kayo, had improved long thereafter, she and her husband were significantly, and she was earning suffi- divorced. cient funds from poetry to begin to save Although I felt obligated not to interfere toward a safari in Africa, which her hus- with the guidelines that had been estab- band had long wanted. lished for Anne’s treatment, in the last year It was rdways clear to me that her hus- of her life, Anne called to say rhat she band was a cmcial part of Aune’s life. This would be in Philadelphia to give a reading was evident even m the beginning, when at the public library and that she hoped she Anne described becoming markedly worse could see me. I expected to see her, but she whenever Kayo had to go away on busi- never made it. Sadly, if in therapy Anne ness trips. Although many therapeutic gains had been encouraged to hold on to the vital had been made horn 1956 to 1964, I felt supports that had helped her build the in- that Anne’s emotional health still depended novative career that meant so much to her heavily on the support she received from and others, it is my view that Anne Sexton her husband and many other people who would be alive today. cared for her. When I left Boston, I ar- ranged to return once a month for several years to see a number of patients for fol- Martin T. (km?, MD, I%D low-up. It was clearly necessary for Anne The Indlute of Pennsylvania Hospiklrl to have another therapist on an ongoing and University of Pennsylvania basis, but I also saw her during my regulm Phikdelph~ PA 19104

Dr. Mrudn T. OrIW’s essay first appsared as rhe Foreword to Anne Sexton.’ A Biowaphy by D@re Middlebrwk, A Peter Davison Book, published by Houghton Mifflin Company, 1991. 01991 by Mardn T. Onre