Uncovering Secrets of a Very Public Poet : Books: A biographer used tapes of Anne Sexton’s therapy sessions as a source. Their inclusion has been criticized as an invasion of privacy.

She has been dead for 17 years, but poet Anne Sexton, the “mad housewife,” once again is riveting the world with tales of her mental breakdowns and how her illness led to Pulitzer Prize-winning poetry.

This time, however, Sexton’s revelations come via a new biography that made use of audiotapes of her therapy sessions with her longtime psychiatrist, Martin Orne. The tapes were released by the Philadelphia psychiatrist with the permission of Linda Gray Sexton, the poet’s daughter and literary executor. Anne Sexton committed suicide in 1974.

Biographer Diane Wood Middlebrook listened to the more than 300 tapes over a two-year period before scrapping her original manuscript and writing a fresh version of the provocative life of Sexton, who championed the “confessional” style of poetry. “Anne Sexton: A Biography” (Houghton Mifflin) was published earlier this month.

But release of the tapes, considered part of Sexton’s confidential medical records, has created a bruising controversy among therapists, including those gathered in San Francisco this week for the annual American Psychological Assn. meeting. On Saturday Middlebrook, a highly regarded professor of English at Stanford University, spoke to the APA’s psychotherapy division about Sexton’s use of therapy to produce intimate poetry on the subjects of suicide, sexuality, incest, love and despair.

While listening to the tapes, “I didn’t feel I was trespassing where a biographer shouldn’t go,” Middlebrook told the meeting. “Anne Sexton was not a very private person.”

But whether Orne was entitled to release the tapes without Anne Sexton’s written permission has overshadowed the issue of what can be learned from them. The tapes were made from 1961 to 1964, just as Sexton was rising to popularity as an uneducated Boston housewife who wrote unabashedly about taboo subjects. Amid a turbulent life of more than 20 hospitalizations, 10 suicide attempts and several extramarital affairs, Sexton published eight books of poetry and won the Pulitzer Prize in 1967.

The tapes were made to help Sexton remember the content of her therapy sessions and thus advance her treatment. Sexton and Orne, who treated the poet from 1956 to 1964, thought the process extremely valuable.

But never did they discuss--or anticipate--a future public release of the tapes after Sexton’s death. Thus, it was the decision of Orne, Sexton’s two daughters and several close family friends that Sexton would have approved of release of the tapes, Middlebrook says.

Linda Sexton retained the final right to veto any material in the manuscript she believed inappropriate. But, she told Middlebrook: “My mother had no sense of privacy. I don’t think I should construct one on her behalf.”

Indeed, Anne Sexton herself acknowledged many times that her life was an open book. When criticized that her play “Mercy Street” was based on disturbing details of her own life and the lives of family members, Sexton replied: “I can invade my own privacy. That’s my right.”

Middlebrook acknowledges that the privacy issue is not clear-cut, but she argues that critics have attacked the use of the tapes without reading the book to understand the context and without knowledge of the explicit ground rules worked out between biographer, therapist and family members. Middlebrook, who returned from a long stay in England only days ago, thanked the APA audience for “a chance of getting a hearing.”

Still, Harvard University psychiatrist Prudence Baxter declares, “I think it sets a difficult precedent for doctors, after the death of a patient, to make a decision with the family members about what the patient would or would not have wanted.”

But typical of the splintering of opinion on the issue, a colleague of Baxter at Harvard, Dr. James Beck, says he disagrees.

“If the client understands what he or she is doing--then I think the therapist is obligated to follow the client’s wishes in that way,” says Beck, the author of a book on doctor-patient confidentiality called “Confidentiality Vs. the Duty to Protect.”

Says Middlebrook, who was asked by Linda Sexton to write the biography in 1980: “The dialogue and debate is fascinating to me. But people have been speaking off the tops of their heads with their criticisms. There is an ethical question here, but it’s not that (Orne) has violated some sort of code. He has created conditions to discuss this issue of how case histories and a patient’s response to treatment are to be made culturally available.”

Orne did not respond to several requests for an interview but wrote in a foreword to the book: “Although I had many misgivings about discussing any aspects of the therapy . . . I also realized that Anne herself would have wanted to share this process--much as she did in her poetry--so that patients and therapists might learn from it.”

Middlebrook says it took writing to Orne for five years to even persuade him to talk with her about Sexton. The meeting finally was arranged with the help of a mutual friend. Middlebrook says when she asked Orne about some details of the therapy, he said he couldn’t remember and added offhandedly, “ ‘I suppose you could check them on the tapes.’ I said, ‘The tapes?’ I didn’t think the tapes still existed.”

Middlebrook says she spent a great deal of time with Orne and Sexton’s daughters discussing what material should be allowed in the book, including about 30 hours on the telephone haggling with Orne over final interpretations of content.

Sexton’s daughters were highly critical of Middlebrook’s first rewrite after listening to the tapes, feeling that the biographer had become overly sympathetic to Sexton and had downplayed the poet’s demands on her family. Once again, Middlebrook revised the manuscript.

The controversy over the tapes’ use has surprised her, Middlebrook says. “You might think that is naive,” she says. “But we had spent so much time working out what we were all supposed to do. Everything was so carefully done. All of us felt our own perspectives were completely represented. We all felt we really did the right thing.”

The exception to this sentiment is Sexton’s surviving sister, Blanche Harvey Taylor, who withdrew her contributions to the book many months ago when she disagreed with Middlebrook’s interpretation of Sexton’s upbringing.

Two startling segments of the book were added late in the evolution of the manuscript, when Linda Sexton revealed to Middlebrook that her mother had sexually abused her and when a woman with whom Sexton had a lesbian love affair, Anne Wilder, gave her permission to write about the affair. Wilder died one week after granting this consent last December.

Middlebrook says also she was careful to guard the privacy of the living, even giving a pseudonym to a Boston psychiatrist who became Sexton’s therapist in 1964 and who began having sex with her during therapy.

Middlebrook says she is surprised that the issue of sex between therapist and patient, which is considered a comparatively common ethical transgression in the field of psychiatry, has received little attention.

“I thought that would be a source of great discussion,” she says.

And, says Harvard’s Baxter: “I found it interesting that people’s concern (with the book) was primarily about confidentiality. The profession seems to be paying very little attention to the fact that (Sexton) had an affair with a therapist treating her at the time.”