Dawn Skorczewski has written a marvelous book, An Accident of Hope, about Anne Sexton's poetry and her psychotherapy with Milton Orne in the late 1950's and early 1960's. Skorczewski listened to all of the extant tapes of the psychotherapy sessions Sexton had with Orne and chose to focus on the recorded sessions that have survived from the last nine months or so of Sexton's treatment. Dawn is a friend of mine, and I must admit that I was not looking forward to reading the book. I thought,"Oh, OK, I'll propose it to the analytic book club and, if they are interested, that will give me a chance to say that I have read it." Dawn is a vibrant person, a good writer and editor who has taught me a lot about writing - and teaching, but I'm not a big fan of poetry, it's just not my genre, and visiting a poet I did not know from around the time of my (and Dawn's) birth and thinking about the antiquated therapy she had undergone just didn't sound exciting.
Well, surprise, surprise. This is a lively and very current book. I was moved and frustrated by the treatment and enjoyed the poetry. Anne Sexton is a woman who had published no poetry before her therapy; she essentially started a poetry genre of self revelation that was a significant cultural step towards the Oprah openness we experience today; and she ultimately won the Pulitzer Prize for poetry. She was also a woman who was seriously ill, was treated by Orne for seven years before being treated by another psychiatrist. The second psychiatrist had a sexual affair with her and Sexton subsequently committed suicide. Dawn elucidates how Anne's engagement in the treatment anticipated the developments that psychoanalytic theory was to discover over the next thirty or forty years. On the other hand, she is a bit critical of Orne who was from her perspective, slow on the uptake and didn't always appreciate what Sexton was laying out for him. This case, for Dawn, illustrated Freud's remark that "Every time I make a great discovery, I find that the artists have been there before me," though in this case the artist got there in the context of therapy as well as in her art.
From my perspective, the interplay of a modern feminist listening to and commenting on the therapeutic interaction between two people engaged in a dialogue that was very much of their moment in history- on the cusp of a feminist revolution - was fascinating. I also appreciated, as a guy with a bit of a poetic tin ear, Dawn's careful but evocative reading of the poetry, and her laying out the therapeutic and personal context of the poems, which brought them to life for me. Delightful. But I also found myself entering the dyad of Sexton and Orne from a very different perspective than Skorczewski. While I empathized with and appreciated Skorczewski's reading of Sexton's subjectivity, I found myself wondering about Orne's. More than Dawn reported herself feeling, I found myself identifying with Orne and feeling that, despite a familiarity with the modern literature that Dawn was citing as a corrective to Orne's technical failings and shortcomings; I might not have been able to make as good use of them as Dawn seemed to imply that I might, and I feared that I might fail in ways, and have failed with my patients, in ways that mirror Orne's failings. That is, I think that some - perhaps not all - of Orne's blind spots might have existed - and the dilemmas he faced might still exist, even though we have a much better understanding of what he was confronting than he did.
Skorczewski, I think rightly, takes Orne to task for two major blunders. Each comes to the fore in a specific period in this last part of the treatment and each is related to a particular part of Sexton's psychology. The first of these blunders, I will call it the error of paralysis, occurs when Orne is first becoming aware that he may leave town (ultimately he does) some nine months hence. Orne becomes particularly inept in his interactions with Sexton, and they talk together about a parallel period of time when Orne withdrew from her during the time when he was afraid to tell Sexton, a woman who had been desperately and at times erotically (in her fantasy life) close to him, that he was going to be marrying. On that occasion, he cut down the number of times that they met per week, quit holding Sexton's hand when she was having difficulty, and asked her to set a termination date, essentially wishing that she would get better so that his news would not upset her.
This time, Martin, a smart, driven man, drawn by his research and ambition to move to another city, refuses to acknowledge how important he has been to Anne - and she to him - and how difficult it is going to be to say goodbye. When she notes that it was he who encouraged her to write, and that the writing has often been directed at him and their work together, he demurs, and rather clumsily - if with apparent good intention - insists that it is she - not her poetry - that is of value. Imagining myself into Orne's experience, I wonder whether he is frightened by how important he has become to her. More than that, he fears, in this woman who has survived multiple traumas at the hands of family members, including her father, mother, and favorite aunt, that he is now becoming a perpetrator himself. By marrying - by leaving - by withdrawing from her, he will injure her, taking away the person she depends on to hold herself together. While we know, as observers, that talking about his leaving, processing the impending ending, is what is most desperately needed, he may fear that to discuss this is to reify it, to make it true and to instigate the very thing that he is desperately trying to stave off - Anne's descent into madness at the hands of a caregiver who withdraws. Because his paralysis creates the very withdrawal he is trying to stave off, an impasse in the treatment develops.
I think part of the problem is that there is a developmental lag for Orne. Sexton is healthier than she was earlier in the treatment (when he tried too quickly to force her to get well). Now that she is better, he still has in mind the danger of pushing her too quickly - and thus does not trust her to be able to tolerate more material now than she, in fact, can. I think another part of the problem is that Sexton is a trauma survivor and the transference/countertransference interaction is sadomasochistic - and Orne, well intentioned, well meaning Orne, has trouble recognizing himself (and Sexton may too) as the instigator of potentially unmanageable distress. This leads him to become defensive - to demonstrate how the treatment has been useful - without casting himself as the hero - trying to avoid overinflating himself, but in the process frustrating Sexton because she can neither love nor hate him - and she wants desperately to do both, and to be able to do both.
I do think that trauma challenges our ability to love and hate the same person. We are called, especially through trauma with caregivers, to try to strain to hold together a positive and a negative view of them, and we end up splitting - seeing others as all good or all bad - rather than integrating them. This is partially, I think, because the psychological space in ourselves that we inhabit to hold our ambivalent feelings together gets pulled apart repeatedly, and we end up with scar tissue there - so we have real trouble standing on that spot and getting purchase, and it is easier to slide to one side or the other. Orne, I am imagining, feels uncomfortable being idealized and devalued and so he tries to make himself into nothing to Sexton, which he most definitely is not, and things crawl to a stop.
The second difficulty for Skorczewski is Orne's reaction to Sexton's narcissism. Skorczewski would have Orne embrace and support it - and she sees evidence of Sexton begging him to do this. She cites theories that Orne does not yet have access to that would help him be able to appreciate the importance of Sexton's narcissism to her maintenance of her self and to her functioning as an artist. I think, though, that Skorczewski loses track of Orne's role as a treater in this moment. Later in the book, Skorczewski is critical of the impact of Sexton's mother's narcissism on Sexton's functioning. Even though Orne overemphasizes Sexton's role as a mother, her maternal role is one that is important to her, and as a treater he may have felt an obligation to her children to try to help her be more considerate - less focused on herself and, without a theory that supports increasing the regard of the treater towards her as a way through the thicket of narcissism, Orne is indeed loathe to follow that route. To further complicate things, Orne's mother, a psychiatrist, originally treated Sexton and Skorczewski provides evidence that she - Orne's mother - is quite narcissistic. Poor Orne - he is treating a woman who has the issues that are unresolved in his relationship with his own mother. This complicates the task tremendously.
I offer the criticisms above not as a critique of the book, but to broaden the perspectives that the reader might take in regard to this unique, powerful therapeutic relationship that we are lucky to have access to via the tapes, but even more through Skorczewski's close and empathic reading of Sexton's experience. The tapes exist because Orne made them to help Sexton have access to the sessions - she would frequently forget material they had talked about and she was tasked with transcribing them as a means of better understanding and remembering them. Apparently Orne used this technique with at least some of his other patients. Unfortunately the tapes between the sessions where an impasse is apparent and later work that is more spontaneous and that demonstrates the real affection that each of these participants had for the other is missing - it would be really helpful to have a roadmap out of the morass of an impasse and back onto the highway of collaborative work.
I also must admit that there were moments when I questioned along with Skorczewski, Orne's treatment, especially when Sexton's husband is choking her and Orne does not intervene more directly. Further, Orne functions as a co-therapist during the time that Sexton is primarily seeing Duhl, her subsequent therapist, and Orne is aware of the sexual affair they have and the difficulties that it poses for Sexton. Even if we didn't know then how disruptive this can be (see a post about Andrea Celenza's work on this); even if our ethical principles and laws did not yet condemn this behavior, it is hard to believe that Orne could not anticipate the difficulties this would cause Sexton and, again, more actively intervene. There is a tragedy here - that someone who could be so helpful ultimately could not provide the kind of help that Sexton really did need.
Despite my misgivings, the book ends up being a very interesting entrance into history, but also, surprisingly, brings up issues about contemporary treatment that are well worth considering. While Orne did not hear Sexton as we can, others were hearing other patients so that we can now hear her, just as we can now hear one of Freud's failed treatments, his treatment of Dora, in ways that his work ultimately helps us achieve, but that were not yet available to him. That said, and despite the tragic conclusion to Sexton's treatment and life, it is also apparent that a less than optimal - perhaps good enough? - treatment helped this woman articulate her experience both in the consulting room and on the page in ways that enriched all of our lives. Tragically, it did not save her life,
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