Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry
Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry; Book Review by Paul…
Anne Sexton: Bipolar Poet and Pulitzer Prize Winner
I just finished Diane Weed Middlebrooks’s biography of Anne Sexton; Houghton Miflin, 1991. Although the biographer does an in depth look at the life of this Pulitzer Prize winning author I am flabbergasted, almost angry, that although obviously bipolar her treatment throughout her adult life consisted of only psychoanalysis and Thorazine.
She was given access to unlimited access to barbiturates for sleep. At the time they and chloral hydrate (the old Mickey Finn drug) were the entire armentarium for sleep.
She was also treated with intramuscular and oral Thorazine throughout her adult life by her psychoanalyst who in his lifetime never made a diagnosis. As in my early days at San Francisco General in the early ‘70s the overdose drug of choice were barbiturates known recreationally as reds or yellows (Nembutal or Seconal). This is the same time frame of Anne’s life (1928 – and her suicide in 1974.) She even called them by their colors.
What makes me so upset is that if she had been treated by a psychiatrist rather than a psychoanalyst (who worried about her childhood) she would have been properly treated and maybe, as in William Lowell’s case, she would not have committed suicide. She also was an alcoholic by the time she died.
I might add that her daughter, Linda, wrote a biography of her mother and draws the same conclusion with angst.
Middlebrook writes: “For all therapeutically oriented readers, Sexton lives on in the enigma of the haunting question intensified by her suicide.
I kept waiting for someone to prescribe lithium, a tricyclic antidepressant and Librium (the first benzodiazepine available at the time) during the critical period of sickness between 1956 and her suicide in 1974. Only in the Coda is this issue emphasized; “…readers who identify passionately with Sexton as a fellow-sufferer view her early death as the outcome of therapeutic ignorance about diagnosis and treatment of these psychodynamic issues.”
The forward of the book is written by Martin T. Orne, M.D., PhD of The Institute of Pennsylvania Hospital and University of Pennsylvania. It was during his ten years in Boston that he was Sexton’s first doctor. The forward is not dated but he states he was involved in her care during the last year of her life. Even then he writes, “What was really wrong with her?”
Anne Gray Harvey was born on November 9, 1928 in Newton, Massachusetts. Her family was rife with mental disease in her father, uncle and great-aunt (Nana) marked by suicide, attempted suicides, depression and alcoholism. These ran up both maternal and paternal sides of the family tree. Ann was one of three sisters. She and Jane would commit suicide.
Her great aunt, Anna Ladd Dingley (Nana) would mostly raise Anne who looked at those years as her happiest. Nana ended up in an institution. At the same time her paternal grandfather had his second breakdown and was hospitalized at Glenside in Boston. Anne would describe this period around her fifteenth birthday. “My father was drinking every minute, Nana was going crazy, my grandfather was crazy, Jane was having a baby…”
Sexton married Kayo Sexton in 1948 at age 19. Two years later the couple became friends with a medical student at Harvard and his wife who was a friend of Kayo’s. His name was Johnny. Thus became the first of many, many affairs Anne had with other men at age twenty-two. Anne’s mother, Mary Gray Harvey, put a stop to it and had her see an analyst, Dr. Martha Brunner-Orne for the first time in 1950. It was also led to one of many suicide gestures (my take) with pills. The family began over time to think Anne was just melodramatic.
Dr. Martha Brunner-Orne saw Anne and after three months of psychotherapy succeeded in ending Anne’s talk of divorcing Kayo. The doctor in her notes wrote that Anne had “difficulty controlling her desire for romance and adventure,” which would also become a life-long pattern.
In 1951, before the birth of Linda and while Kayo was in Korea, Anne was restless and bored. She began seeing other men. “when I say running I don’t mean running from something, but something I express by action – people, people, talk, talk, wanting to stay up all night, no way to stop it. I don’ really want to have an affair with anyone, but I have to ….”
Upon return of Kayo she became pregnant in July, 1953. Anne was twenty-five. This would be the first of two children, Linda and Joy. After the birth of Joy she had the first of many breakdowns. She looked forward to children but once having them she was not happy with being a housewife. She went through the first of many depressions. At this point she began to see, Dr. Martin Brunner- Orne in 1956 after the birth of Joy. He was the son of Martha Brunner-Orne. She was seeing him as an analyst although he was trained as a psychiatrist as well.
At one point she was diagnosed with post – partum depression. She even “developed a morbid dread of being alone with her babies.” A pattern developed that whenever Kayo was away on business she would develop depression, anorexia, and stomach pain and anxiety attacks felt by her doctor to be psychosomatic. Eventually she started having rage attacks even physically abusing Linda, her oldest.
She began abusing barbiturates prescribed by Dr. Orne. She began to take them nightly and in larger amounts which led to her first hospitalization at Westwood Lodge. This was a private psych facility more like a home away from home.
On her twenty-eighth birthday, alone, she took an overdose of barbiturates, Nembutal. Forever thereafter she would call these her “kill me” pills. This time Dr. Orne admitted her to Glenside a typically scary psych facility where she stayed for three weeks. “Dr. Orne wrote that Sexton was one of the few patients at this hospital who did not receive electroshock therapy. The doctors recommended it but he chose five times a week psychotherapy.
At this point Billie, her mother in law, would take over the care of the children for many years. At this point Anne wrote “My sexual life is in reality a hideous mess and I don’t understand it and furthermore I don‘t want to discuss it or understand it…Here I am so oversexed that I have to struggle not to masturbate most of the day – and I certainly don‘t want to discuss that –but its true nevertheless –and when Kayo starts to make love to me I can’t concentrate on it…”
Of one of her admissions Orne wrote “that he doubted that she had an organically based depression.” Middlebrook notes that he said this despite a strong family history and “extreme physiological symptoms: wildly alternating moods, anorexia, insomnia, waves of suicidal and other impulses, rages, rapid heartbeat. It is possible that biochemical imbalances throughout her life intensified the underlying psychological vulnerabilities that were the primary focus of her psychotherapy.”
The author goes on to quote Dr. Orne’s notes once again: “She was very, very sick, but like many interesting patients didn’t fit textbook criteria.” He briefly thought she might be schizophrenic while in hospital but wrote that off to lack of disassociation or delusional symptoms. … In retrospect, for the prologue to Middlebrook’s book Dr. Martin Brunner-Orne, son of Martha Brunner-Orne who began to see her in 1956, writes “She certainly had a depressive illness for many years, which was never really resolved. One wonders whether the new antidepressant drugs might not have successful treated the more serious aspects of her depression.” The text does not say when he recalled these events. The prologue is not dated!!
Yet, tricyclic anti-depressants were developed in the early ‘50s and began to be used by 1956. Also, lithium carbonate had begun to be used for bipolar mania. It was not officially released for use in bipolar disease but as you remember above it was first used for Robert Lowell with dramatic results in 1956.
Dr. Martin Orne did have a life-changing suggestion to Anne. At one her first interviews with Orne in 1956, Sexton told him that her only vocation might be as a prostitute. He told her that she had a great deal of untapped creativity. Thus began her poetry which she would share with him at their sessions. After positive feedback from him she began her career as a poet, initially sharing were work with Dr. Orne by 1957. Middlebrook writes, “She compared herself to Robert Lowell, Sylvia Plath and T.S. Eliot. She felt a kinship to these and others because they were mad too. ‘These are my people.’”
In 1958 Kayo became upset with paying all Sexton’s medical bills. He told Dr. Orne, “It is my personal belief that she is playing us all for a bunch of suckers, and she has no intention of ever assuming her family responsibilities…”
Despite the turbulent years beginning in 1950, by 1958 Sexton had over sixty poems in circulation waiting for publishers. She was getting offers from Harper’s and the New Yorker. She had an abortion from an unknown relationship.
She then attended Antioch College where her circle of friends included Nolan Miller who described her as “Flirtations, Bawdy and Funny…Dashing. Flamboyant. Spectacular. A house on fire… she appeared to be in a state of exhilaration…a constant high.”
Sexton joined a working group run by Robert Lowell in 1958 and along with other “students” she gave her first public reading of her poetry. She met fellow poet Sylvia Plath and they became drinking buddies. By the fall of 1958 George Starbuck, an editor for Houghton Mifflin, was pushing for the publisher to accept Sexton’s book of poems. Sexton and Starbuck became lovers. Sexton: “… pets were always in love.” They met for drinks at the Ritz and then whiled away the afternoons for sex. It goes without saying that Houghton Mifflin published To Bedlam and Part Way Back eventually in 1960.
Now at thirty-three Anne did decide she needed to arrange her recent poems into a one book in four sections. All My Pretties was written while Kayo and Orne were out of town and while editing it Anne became suicidal. At a restaurant she brought the manuscript to a restaurant with a note in the margin instructing her good friend Maxine Kumin what changes to make. She had a beer and took an over dose of pills. Not a lethal amount she went home and vomited. She called Orne’s substitute for hours wanting to go to Westwood. But, with Kayo soon to arrive home she just took a usual dose of Deprol to calm down. This is benactyzine an anti-histamine like Benadryl used for depression and anxiety before being removed by the FDA due to its ineffectiveness.
By 1963 Anne, having published her poems began travelling and performing readings. She was considered one of the most important poets on the American scene. She achieved all this since 1958 despite continued depressions and psych admissions. Over the next decade she would go one to win all major prizes. Oxford University Press published Selected Poems. All My Pretty Ones was almost the National Book Award winner. She received the traveling fellowship of the American Academy of Arts and Letters.
She was devastated when Sylvia Plath died in February of 1963. Although signed out as pneumonia, she actually had put her head in the oven and died of asphyxiation. In response, Sexton told Dr. Orne “suicide is like a drug. The person who takes drugs can’t explain why they want to do it. There’s no reality reason.”
Using the grant from the American Academy of Arts she gave readings in Europe. Her pattern of affairs did not cease in Europe. In Rome she met a Yugoslavian barber named Louis. When she left Louis’s only fear was that she might be pregnant.
In October, 1964, Dr. Orne accepted a teaching position at the Institute of Pennsylvania Hospital in Philadelphia. “For Hemingway to shoot himself,” she told Orne, “with a gun in the mouth is the greatest act of courage I can think of…I worry about the minutes before you die, that fear of death. I don’t have it with the pills, but with a gun there’d by a minute when you’d know, a terrible fear. I’d do anything to escape that fear; death would be a friend, then.” Sexton described Plath’s death by asphyxiation as “a woman’s way.” In 1964 Dr. Orne suggested Dr. Ollie Zweizung as his replacement when he went to Philadelphia.
While writing a play and near Orne’s departure she wrote, “ I’m not (overtly) depressed…on no. MANIC… That is what was driving the machine that drove the play that drove me….” She ended up at Massachusetts’s General Hospital’s psychiatric ward for two weeks.
Then, finally, she was started on a course of medication; Tofranil was ineffective so she was given Thorazine used in 1964 for psychosis and mania. Sexton developed tremors and facial distortions, which strongly emphasized the asymmetry of her features. All are known side effects oh Thorazine as well as excess burning in the sun.
While taking the drug, she felt that her creativity had entirely dried up. She wrote to a friend in 1965, “The g.d. tranquilizers that I started to take at M.G. H. this summer have completely stoppered any original idea. I haven’t had one since the first madness.”
Nevertheless, Anne was elected to the Fellow of the Royal Society of Literature. She churned out redone old poems as well as new ones. How? During months here and there she stopped the Thorazine either to regain her creative imagination and even to go to the coast to get a suntan.
Eventually she had a long running affair with Dr. Ollie Zweizung!! A stop was eventually put to this by Dr. Orne without Zweizung losing his license for such unethical behavior, particularly for a psychiatrist. She began seeing Constance Chase.
Shortly thereafter Sexton fell down some stairs and broke her hip. After over six months of resting she roared back in 1967 to win the Shelley Memorial Prize and the Pulitzer Prize. She was now a celebrity.
Between 1970 and 1972 Sexton became a professor at Boston University. This did not stop the occasional manic collapses and visits to Westwood Lodge. Following those would be deep depressions. By 1973 her despair, “demons,” took over her life. She described herself as “with two days out for despair and three days out in a mental hospital.”
The rest of her marriage was marked by arguments with Kayo while both were extremely inebriated. After searching and failing to find male companionship with several old friends life became a series of hospitalizations and downhill health to the point of weighing only 110 pounds at 5’10. She cycled in and out of psych facilities and developed a routine of cocktails on top sleeping pills. In October of ’73 she ended up at the Human Resource Institute of Boston for one month.
With failing eye sight and issues of dental abscesses she would live for less than a year. Alcohol became her chief medication.
She took an overdose of Thorazine in February of 1974 and was not found for twenty-four hours at which time she was comatose. Upon regaining consciousness she told her companion, Lois Ames, “You won’t get another chance to save me…”
Indeed, on Friday, the fourth of October. She feigned being happy with some friends and alone she died from carbon monoxide poisoning in her garage.
As Kaye Redfield Jamison lists in her book, Touched with Fire: Manic –Depressive Illness and the Artistic Temperament, (Simon Schuster, 1993) many poets and writers are destined to the ultimate sacrifice: Anne Sexton, Sylvia Plath, Ernest Hemingway and Virginia Woolf to name a few. Even in recent months this was the end for designer Kate Spade and chef and host of CNN’s Parts Unknown, Anthony Bourdain. I am currently reading the first authorized biography of Robin Williams. (Robin by Dave Itzkoff, 2018, Henry Holt)
Despite effective medications, self-stigma, not seeking psychiatric help, not starting or stopping medications, no support person this is the case for 44,000 suicides a year in the U.S. However, some of those afflicted keep in the back our minds: a way out if the depression or bipolar depression become intolerable. Read Virginia Woolf’s suicide note to husband Leonard.