Author Interview: “An Accident of Hope” — Analyzing the Psychotherapy of Anne Sexton

An Accident of Hope is a fascinating read for anyone interested in writers, writing, psychotherapy, women, medical ethics, and American society just before the great upheaval of the 1960s.

An Accident of Hope: The Therapy Tapes of Anne Sexton by Dawn M. Skorczewski. Routledge, 268 pages, $35.95.

By Helen Epstein

Occasionally, a professional book comes my way that’s aimed at a narrow academic market but contains so much interesting and powerful material that the general reader should know about it. An Accident of Hope: The Therapy Tapes of Anne Sexton by Dawn M. Skorczewski is such a volume. Taking as its focus the innovative audiotapes of Anne Sexton’s therapy sessions with Dr. Martin Orne in Boston from 1960 to 1964, it’s a fascinating read for anyone interested in writers, writing, psychotherapy, women, medical ethics, and American society just before the great upheaval of the 1960s.

Recording and transcribing tapes of psychotherapy sessions was a radical idea in 1960, and it makes some professionals uneasy even today. They believe that making such tapes available to the public, and publishing books based on them without explicit written authorization by the patient, is an unethical breach of confidentiality. This breach violates a basic tenet of psychotherapy. It opens up not only the patient’s intimate life and problems but the thinking of the therapist who treated her: his methodology, biases, mistakes, and strategies. So it is with a sense of transgression that we listen in on Anne Sexton and hear an example of psychotherapy as it was practiced in Boston in mid-twentieth century.

I had heard about An Accident of Hope even before the author signed her contract to write it and was fascinated by the possibilities. Anne Sexton was a rebellious woman who led a flamboyant marital and extra-marital sexual life and wrote about it long before other women did. Born into a WASP family in Boston, she defied Yankee notions of modesty, reticence, and self-containment. Her story also contradicts artistic fears about the anti-creative power of psychotherapy. A desperately ill patient, Sexton found her calling as a poet as a direct consequence of her treatment.

As we know from Diane Middlebrook’s 1991 biography Anne Sexton: A Biography, Anne Gray Harvey Sexton was a brilliant, provocative, and self-destructive twentieth-century confessional poet. She was born in 1928 in Wellesley, Massachusetts and lived for the rest of her life in Weston and Newton, two affluent western suburbs of Boston. She belonged more or less to the same generation as Adrienne Rich (1929–2012), Sylvia Plath (1932–1963), and her good friend Maxine Kunin (1925– ), but, unlike them, she was neither encouraged to write nor to attend college. Her parents viewed Anne as a party girl. As a teenager, she published poetry in her high school newspaper, but Anne quit after her mother (herself a frustrated poet) unfairly accused her of plagiarism.

In 1948 when she was 19, Anne fell in love with and quickly married handsome college student Alfred Muller Sexton II (“Kayo”). The couple lived for a short time at Colgate University, then in the homes of their parents, then, when Kayo joined the military, in San Francisco. By 1956 they had their own home in Newton Lower Falls and two daughters. Kayo worked as a traveling salesman and, alone with her two children for days at a time, Sexton became increasingly depressed. As her younger daughter Joyce approached her first birthday, Anne, then 28, became suicidal. She was admitted to the psychiatric hospital Westwood Lodge for post-partum depression and became the patient of 29-year-old resident psychiatrist Martin T. Orne. They worked together at least twice a week, sometimes three, for the next eight years.

During those pre-feminist years of the Eisenhower Administration, Dr. Orne asked Sexton whether there was any profession she thought she was fit for. Sexton allegedly replied, “prostitution, because I think I could make men feel sexually powerful.”

Dr. Orne suggested instead that she try her hand at writing, and, after watching a PBS special on poetry, Sexton enrolled in a class at the Boston Center for Adult Education, where she and Maxine Kunin became fast and mutually protective friends. “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,” Kumin wrote later. Although Sexton often thanked Kumin and her male poetry mentors for their help, it was her therapist whom she credited for her career as a poet. Dr. Orne, for his part, consistently distanced himself from Sexton’s belief. He repeatedly emphasized that she was the sole author of her work and that her worth was separate from that of her poetry. When, for example, she said to him “My poems are my accomplishment,” he replied “No. You are your accomplishment.”

Her first collection of poems, To Bedlam and Part Way Back, nominated for the National Book Award in 1961, contains several references to her therapist. The first poem in the volume, “You, Dr. Martin,” begins

You, Doctor Martin, walk
from breakfast to madness. Late August,
I speed through the antiseptic tunnel
where the moving dead still talk
of pushing their bones against the thrust
of cure. And I am queen of this summer hotel
or the laughing bee on a stalk

“As Dr. Martin walks from the sensible world of his breakfast ‘to madness,’” Skorczewski explicates, “he traverses the clear boundary between the inside and the outside worlds. The ‘I,’ in contrast, moves between observation and participation in a world that rapidly shifts from ‘tunnel’ to ‘hotel’ to ‘stalk.’ Beginning with long hospital hallways as tunnels, the speaker turns the hospital into a ‘summer hotel,’ a temporary dwelling-place, and then into a ‘stalk,’ a part of a living plant, which we presume is outside. The image of the speaker as a ‘laughing’ Queen Bee is undoubtedly feminine, with its incumbent suggestion of generativity. We may associate the speaker’s queenly role with power, but the surrounding images remind us that her power extends only to the walls of the hospital.”

In addition to supplying a close reading of this and other poems, Skorczewski examines the classical psychoanalytical theories that governed Dr. Orne’s treatment of his patient. Sexton, she argues, understood psychotherapy differently, much in the way contemporary relational psychologists do. The poet “underlines the fact that she and Orne are a uniquely creative dyad (“no one else will do”). Orne helps her to nurture the creativity that she had shown as a child but that had not received her parents’ praise. But perhaps too, Sexton recognizes that she and Orne were a uniquely qualified couple, able to make together what she herself had not seen how to create in the past. Skorczewski argues that Orne’s “refusal to recognize or name his role in the creation of Sexton’s poetic persona seems simply inaccurate.”

“Said the Poet to the Analyst,” also in Sexton’s first volume of poetry, points out the differences between the poet and the therapist:

My business is words. Words are like labels,
or coins, or better, like swarming bees…..

Your business is watching my words. But I
admit nothing. I work with my best, for instance,
when I can write my praise for a nickel machine,
that one night in Nevada: telling how the magic jackpot
came clacking three bells out, over the lucky screen.
But if you should say this is something it is not,
then I grow weak, remembering how my hands felt funny
and ridiculous and crowded with all
the believing money.

“Although the speaker’s powers of creation reverberate in stanza one, the second stanza reveals how heavily she relies on the presence of the Analyst to witness her creative efforts,” Skorczewski explains, “the speaker needs the doctor if she is to make meaning, even if the meaning she seeks goes beyond his understanding of what it could be.”

Poet Anne Sexton -- suffered from hysteria.

In conducting therapy with Sexton, it became apparent to Dr. Orne that while each of their sessions seemed to have a beginning, middle, and end, there was little carry-over from one session to the next. After months of psychotherapy, Sexton could not remember much from one session to the next. “While to some extent each of us is selective in what we remember,” wrote Orne in his foreword to Middlebrook’s biography, “Anne’s selectivity was extreme in the sense that she literally remembered almost nothing of relevance from one session to the next…. she had a condition that was traditionally known as hysteria.”

Orne concluded that it was “necessary for Anne herself to become the one responsible for remembering what we were doing together.” He urged her to take notes after sessions and, when that proved unsuccessful, he suggested recording them. As he explains in the foreword,

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 upset about something someone had said, or why she had been angry at me. . . . 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 ….

Orne acknowledges that this procedure had led to some “embarrassing moments for me as the therapist—since Anne was able to point to errors in my memory of prior sessions,” but he writes that “it was a unique experience for Anne to know more about what transpired in her treatment than her therapist did. . . . Whereas the therapist usually holds all the cards, the patient now could know more about what was happening in treatment than the therapist did. Indeed, Anne made a major step forward when she was first able to show me that I was wrong!”

In 1991 when Diane Wood Middlebrook published her biography of Sexton, she disclosed that four years of Sexton’s psychotherapy tapes had been made available to her by Dr. Orne. Her disclosure sparked a controversy over patient confidentiality, therapeutic ethics, and literary voyeurism that has still not died down in some quarters of the mental health community.

“A patient’s right to confidentiality survives death,” Dr. Jeremy A. Lazarus, the chairman of the ethics committee of the American Psychiatric Association told the New York Times then. “Our view is that only the patient can give that release. What the family wants does not matter a whit.” Ted Hughes, the poet and husband of Sylvia Plath, was cited for having destroyed parts of Plath’s diary to spare the feelings of their children. However, Linda Gray Sexton, one of Anne’s two daughters, helped her mother’s biographer.

“Hundreds of pages in newspapers, popular magazines, and professional journals were devoted to the issue,” Skorczewski writes. “Most health professionals argued that Orne violated doctor/patient boundaries and compromised the treatments of other patients when he released the tapes. People from the literary community contended that Sexton made a professional life out of the kind of self-exposure that many patients fear.” First amendment rights and feminism issues complicated the debate. Dr. Orne himself wrote about his decision, reporting that Sexton herself suggested that the tapes might prove useful to others in despair.

I would have liked to review An Accident of Hope, but Skorczewski, Associate Professor of English and Director of University Writing at Brandeis University, invited me to guest lecture at a class on Holocaust writing two years ago and discussed her research with me over a period of a few months. Journalistic ethics disqualify me as a reviewer but not as an interviewer.

I talked to Professor Skorczewski just after An Accident of Hope: The Therapy Tapes of Anne Sexton was published this month.

Arts Fuse: Would you tell me how you first came across Anne Sexton’s poetry and your reaction to it?

Skorczewski: As a graduate student in English Lit, beginning my dissertation at Rutgers, I came upon Sexton’s work while looking for poems that represented father/daughter incest. I had been pursuing a Victorian theme, about daughters running away from home in novels, when I suddenly asked myself why they were running away and found myself replying “incest.” I was astonished to discover that my mother’s incest story, which I’d heard from her sister, my Aunt, had found its way into my dissertation.

Once I acknowledged that, I changed my topic. I decided to write about explicit representations of incest and found Sexton’s work. Her honest and lyrical portraits of abused daughters really spoke to me. I felt that I had found a woman poet who looked her pain in the face and wrote about it. Later, I realized the complexities of her efforts to tell “the truth the dead know.”

AF: How did you proceed?

Author Dawn Skorczewski — She had no second thoughts about publishing the tapes of Sexton

Skorczewski: I read Sexton’s poetry and decided on the poems that I would study. This was in 1991. I waited for the Middlebrook biography to be published. I was surprised and frustrated when her biographer expressed certainty that Sexton had never been sexually abused. I think my desire to listen to the therapy tapes started there, because I wanted to hear Sexton discussing this issue with my own ears in order to make my decision. I disagree with her biographer about the sexual abuse. I first found Sexton to be a kind of mother figure to me: enraging, comforting, creative, stimulating. Later, I began to feel more like her sister and sometimes even her mother. What a terrible load of mental illness, childhood misery, and cultural entrapment she lived with . . . .

AF: Who were you working with on this very intimate and potentially explosive material?

Skorczewski: Alicia Ostriker, the poet and also a Sexton scholar. A wonderful coach, she simply asked for 20 pages every two weeks. They were returned with small, penciled additions and deletions but never much criticism. She made it so easy, if that can be said about writing a dissertation!

AF: When did you get interested in psychoanalysis?

Skorczewski: In the mid-nineties, when a close friend described its benefits for her. It had changed her life to be in analysis, and she told me because I was looking to change mine. I ended up starting a 12-year analysis with a wonderful woman who helped me address my basic lack of self worth. But she also indirectly stimulated an interest in learning more about contemporary relational analytic theory and infant research. I learned that contemporary theory had moved far beyond the model of analysis that is still deeply entrenched in our cultural myths about the process. In fact, contemporary analysis, with its feminist, post-structuralist tenets, is much more complementary to my thinking about life and literature than I might have imagined when I was working on Sexton and psychiatry way back in 1991. I was an Affiliate Scholar at the Boston Psychoanalytic Institute for three years and especially enjoyed the clinical classes, in which I learned to think about the clinical situation from a less literary perspective.

AF: After the Middlebrook biography was published and both the literary and therapy communities condemned Orne (see Michiko Kakutani’s review in the Times), did you have any second thoughts about using them?

Skorczewski: None whatsoever. I am confident that Sexton wanted to help people by sharing her struggles to get well. I heard her say so on the tapes.

AF: How did you gain access to them?

Skorczewski: I wrote to Linda Gray Sexton in 2004 asking if I might have access to the collection in the Schlesinger library. Sexton immediately gave me permission. I listened to the first tape in 2004 and the last ones, in Austin, in 2011.

It took me many years to find a way to make an argument about the tapes, which are difficult to listen to from start to finish because they are so painful. Sexton was a very sick woman when she started with Orne. By the time eight years had passed, she was an accomplished poet and much less depressed. But she was hardly cured.

AF: How would you characterize Dr. Orne’s psychotherapy?

Skorczewski: When I listened to sessions in which Sexton sought connection with Orne, I was struck again and again by how Orne missed her efforts to reach him and instead focused on her problems dealing with “reality.” True, Sexton hid from her pain, which was part of the reason that Orne asked her to tape each session and listen to it before attending the next.

Anne Sexton in the summer of 1974

But if he had been sensitized to the feminist and relational theories that I discuss in my book, Orne might have focused on Sexton’s attempts to develop a new kind of relationship with him. He would have praised her for achieving moments of connection and honesty that were rare for her outside the consulting room. He might have focused also on her contributions to him—Sexton said “you know I’ve changed you, too”— he might have given Sexton credit for urging him towards more authentic, less theory-driven interactions with his patients. Had they continued to work together, I am sure that Sexton would have continued to improve.

AF: Instead, of course, Dr. Orne left Boston in 1964 for a position in Philadelphia, and Sexton went on to work with a less scrupulous therapist.

Skorczewski: Unfortunately, her next therapist, Dr. Frederick Duhl, entered into a sexual relationship with her, which was not what she needed. I heard a bit about the boundary violating Duhl on the final tapes, released last June, which I gained access to in April 2011. Linda Sexton agreed with my assessment that enough time had passed for researchers to be allowed to see and hear this material.

AF: You’ve tackled an extraordinary subject. If you had to tell the general reader what you aimed to do in An Accident of Hope in two sentences, what would you say?

Skorczewski: I wanted to consider Sexton’s therapy, poetry, and the cultural context of her time simultaneously. I tried to show how the therapy influenced the poems, and how the poems, less obviously, pointed to new directions that psychotherapy and psychoanalysis would take in the decades to follow.

Coda: Sexton lived and continued to write for 10 more years after ending her therapy with Dr. Orne. In 1967, she received the Pulitzer Prize for Poetry. She published Live or Die (1966), Love Poems (1969), the play Mercy Street (1969), the prose poems in Transformations and The Book of Folly (1972), and The Death Notebooks (1974). The Awful Rowing toward God was published after her suicide in October 1974. She died of carbon monoxide poisoning in her car after lunching with her long-time friend and sister poet Maxine Kumin. In a few weeks, she would have been 46 years old.

Helen Epstein is the author of Children of the Holocaust and editorial director of Plunkett Lake Press eBooks , an electronic press specializing in books about Central Europe.


  1. Shelley on April 24, 2012 at 1:34 pm

    Yet another reason to be thankful for PBS.

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