From: mtaranto@shearson.com (Mark Taranto)
Subject: Re: A question of ethics regarding literary biographies
Organization: Yale CS Mail/News Gateway
Date: Fri, 13 Nov 1992 19:36:30 GMT


Last week, I posted something about the controversy regarding Diane
Middlebrook's use of tapes of psychiatric sessions between Anne Sexton
and her psychiatrist, Dr. Orne.
 
At the conclusion, I wrote:
 
] As for my opinion?  I think that in general it is unwise for a
] psychiatrist to discuss anything that goes on in his office.  But
] given the wishes of her heirs, the fact that much of the information
] is available in notes, the fact that time has passed since her death,
] and the fact that he has good reason to believe that Anne Sexton would
] have wanted him to disclose the information, I think he made the right
] choice.
 
When I posted it, I also sent a copy to Fiona Webster, thinking that
as a psychiatrist, she might have something interesting to say on the
subject.  She responded by e-mail, and gave me permission to post her
response.  Here it is, with my response to her questions.
 
 
> Mark--                                   Friday AM, 11/6/92
 
> I can't find your posting about the Sexton book, so I'm answering
> by e-mail.  Here's what I would have posted, which you may quote
> in a posting, if you wish:
 
> I appreciate your respect for my opinion, Mark, and it's certainly
> an interesting ethical conundrum, but the fact of it is, I'm
> not an expert on medical ethics.  It's not a field I've studied in
> any depth.
 
> I can't even answer the question in the form "Would I have released
> the tapes if I were in that position?" because it's a uniquely
> complicated situation--all the factors you adduce seem relevant,
> and the patient's being dead puts her (as far as psychiatry is
> concerned) out of harm's way.  I can't know what I'd do, because
> I would base my decision based on my own relationship with the
> patient--how, in my judgment, she would have felt about releasing
> the tapes.
 
> Anne Sexton committed suicide, didn't she?  If she were under the
> care of this psychiatrist at the time of her death, that would put
> an odd wrinkle into the question of the psychiatrist's motivations.
> Is he trying to make up for what he feels to be a failing on his part,
> by contributing to Sexton's textual immortality?  Why did he not make
> a decision about the disposition of the tapes--either destroy them,
> or turn them over to her legal literary executor--at the time of her
> death?  I know I would not have felt comfortable, simply holding onto
> them, because who knows, I myself could die, the tapes would be found
> in my files, and then I'd have no role at all in the decision.  I keep
> personal notes on my patients, even after they've died or left my
> care, but they are labeled only with the patient's initial, with no
> identifying information.  I never make audiotapes, but I do, rarely,
> make videotapes of sessions.  In these cases, I either erase the
> tape soon after viewing it in the company of the patient, or, if
> the tape is for teaching purposes, I always have an explicit contract
> with the patient that I will show the tape only in a few (specified)
> teaching sessions, and will erase it afterwards.  (I also offer to
> turn the tape over to the patient, but so far, no one has wanted
> to keep it.)  So I do wonder a bit about how Sexton's psychiatrist
> justified his decision to hold onto those audiotapes after the
> patient's death.
 
Anne Sexton did commit suicide, but had not been under Dr. Orne's care
for 10 years.  In 1964, Dr. Orne left his position at Harvard for one
at The University of Pennsylvania.  He continued to see Anne Sexton
once per month for several years.  At this time, she entered analysis
with another psychiatrist.  She eventually had an affair with the
second psychiatrist -- which led her to drop him and go to a third
psychiatrist, a woman.  This doctor felt that it would be best for
her to cut off her relationship with Dr. Orne.
 
Not long after that, Anne Sexton's marriage ended.  Throughout her
marriage, she had several affairs, but relied on her husband for a
sense of stability.  When he was away on business trips, or she was
away for an extended period of time, she would often have hysterical
fits, and had to be hospitalized.  She relied heavily on those who were
close to her, especially on her husband and Dr. Orne.  Orne felt that
the fact that she lost some of those whom she relied upon so heavily,
in quick succession, contributed to her suicide.  Much of this is
explained by Orne in the introduction which he wrote for Diane
Middlebrook's biography of Sexton.
 
I didn't have an answer for Fiona's question about why he did not
return the tapes, but I just discovered it.  I am reading the QPB
version, which is the same as the hardback version.
 
I noticed that the paperback version is now out in bookstores.  It has
an addendum which deals with this issue.  When the book first came out,
several people in Medical Ethics condemned the use of the tapes.  Some
felt that his obligation of confidentiality to the patient extends beyond
death, and that only the patient, not her heirs, can give a release.
Other's felt that once the Sexton was dead, she was, as Fiona put it,
out of harm's way -- so the question of release was up to her daughters.
One doctor said that he would have tried to talk Sexton into taking the
tapes.
 
Orne responded to some of these questions. He said that it is now
common practice to obtain a release from patients to use materials
from their therapy for teaching or other reasons.  In 1964, a formal
release was not standard practice.  In addition, he states that he
asked her to take the tapes when he stopped treating her.  She told
him to keep them, and to use them as he saw fit.
 
I wrote back to Fiona with some of this information, including my
speculation as to why Orne actually kept the tapes (saying perhaps it
had something to do with her literary reputation).  She responded:
 
> Interesting information.  But her being an important literary figure
> can't be a justification for his having kept the tapes, because the
> decision is a simple either-or: either destroy them, or, on account
> of her being a literary figure, turn them over to her executor.  The
> non-decision--just holding onto the tapes--is irresponsible, in my
> view, because it leaves open the possibility that the tapes will fall
> into someone else's hands--someone who is *neither* Sexton's faithful
> doctor, nor her legal executor.
 
I have to agree that he should have handed over the tapes when she died.
 
 
Mark
 
 
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