To Bedlam and Part Way Back: Anne Sexton, Her Therapy Tapes, and the Meaning of Privacy

The poet Anne Sexton committed suicide in October, 1974, at the age of forty-five. Three months earlier, she had celebrated the 21st birthday of her elder daughter, Linda Gray Sexton, and on that occasion appointed her as Sexton's literary executor. Anne Sexton provided detailed instructions in her will about the disposition of her papers. She made no mention, however, of the four audio tapes of her psychotherapy sessions that were later found. She also did not mention the over 300 therapy tapes that were still in the possession of her principal psychiatrist, Dr. Martin Orne. After Anne Sexton's death, Linda Gray Sexton created an inventory of her mother's papers and transferred their ownership to an archive at the University of Texas. She placed the four tapes and the notebooks in which the poet wrote down her thoughts and reflections of the therapy sessions in a restricted part of the archive. When Linda Gray Sexton asked Diane Wood Middlebrook in 1980 to become her mother's biographer, she agreed to give Middlebrook full access to her mother's estate, including the four tapes and the therapy notebooks. She also authorized Middlebrook to consult with Dr. Orne. In 1986, after Dr. Orne told Linda Gray Sexton that he still possessed the remaining therapy tapes, he made them available to Middlebrook. While Dr. Orne did not explicitly request Linda Gray Sexton's permission to disclose the tapes to Middlebrook, he knew that Sexton had veto power over anything in the biography that she found objectionable to the family. He also had received legal advice to the effect that in most jurisdictions a literary executor could get a court order requiring the release of medical records. In addition, Dr. Orne knew that Middlebrook had already obtained the most sensitive material involving Sexton's life and psychiatric treatment from the therapy notebooks and other biographical sources. Before releasing the tapes, Dr. Orne discussed at length with Middlebrook the issues raised in the manuscript of the biography, and was convinced that nothing "new" in terms of salient biographical information would be gleaned from the tapes. As a biographer, Middlebrook felt that the process of listening to the tapes would provide her with insight into Sexton that she could not gain through any other medium. The psychiatric and the literary communities' response to the publication of Middlebrook's biography in July, 1991, was immediate, impassioned, and well-publicized. Some claimed that by releasing the tapes to the public, Dr. Orne breached "the contract of confidentiality that always exists between psychotherapist and patient" and that his action betrayed the profession. Others, in contrast, felt that the decision to disclose is the patient's - or the executor's - and that the issue is one of "public taste and public opinion." Sexton's close friends and colleagues defended the act of disclosure, while her extended family condemned it. The issues involved in the release of the tapes are highly charged and controversial. The questions raised require examining the intersection of theories of law, medical ethics, and artistic expression. A full analysis implicates not only the legal doctrine of substituted consent and the ethical issue of doctor-patient confidentiality, but also the relevance of Sexton's status as a confessional poet and as a woman. An awareness and understanding of each of these areas is neces-sary to inform a meaningful discussion of the whole. The psychiatric establishment and the media framed the key issue in the controversy as whether Sexton herself would have wanted the therapy tapes to be made accessible to her biographer and, therefore, made public. Given that it is impossible to be certain what Sexton would have wanted under these specific circumstances, the question instead might be whether to release the tapes at all, in the absence of clear evidence of her preference. It is most productive, however, to view the debate as a challenge to conventional no-tions of privacy while offering a glimpse of new (but not untroubled) ones. Contemporary consternation over disclosure of the therapy tapes mirrors early criticism of Sexton's poetry. While the object of the censure is different - a psychiatrist's decision rather than a poet's words - the motivation is similar: the desire to maintain the status quo. Sexton's writing and therapy were interwoven and interdependent. In both contexts she explored topics integral and specific to her identity as a woman, from parenting and bisexuality to domestic violence and incest. In her writing, Sexton often suggested a theme or expressed an emotion that she had not yet explored or acknowledged consciously. In this way, her poetry illuminated her inner life just as the process of psychotherapy enabled her to become a poet. In both forums, Sexton inverted the distinction between public and private and challenged gender norms. This Essay addresses the issues raised by the release of Anne Sexton's therapy tapes. First, it considers the interre-lationships among Sexton's poetry, her psychotherapy, and her identity as a woman. Second, this Essay places the tapes within the legal doctrine of surrogate decision-making. Related to this inquiry is a discussion of doctor-patient confiden-tiality and the psychobiography of artists. Throughout, the Essay explores difficult questions about the nature of privacy and autonomy and the impact of gender upon these concepts. In addition, a contextualized, fact-specific analysis is emphasized, one that draws upon - rather than minimizes - the paradox, tensions, and ambiguities expressed by the debate itself.