Monday, October 5, 1998
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3 pm. Initial Session with Darius Booth. Darius is an intense, driven young man. Born in Australia to an American mother and an Australian father, Darius grew up on a dairy farm in the South West of Australia. His mother was killed in a tractor accident when he was just a baby. Darius wants to be a stand-up comedian. He feels that he is compelled to do it--like a religious calling. However, he has taken a philosophical view of comedy, apparently. He has a routine from which he won't deviate but which he admits doesn't provoke laughter. He's been barred from a number of performing venues already. Being an unfunny comedian sounds like a kind of personal hell--public rejection and humiliation nightly. Obviously, Darius can't earn a living at his comedy, so he works doing accounting tasks. In addition to bringing in a paycheck, he looks on his various jobs as providing a form of emotional stability. Darius likes jobs which enforce a strict routine--he analogized it to a Chinese Tea Ceremony. He is working as a clerk in the accounts payable department at SII. He told me about his daily tasks and they seem almost soothing for him--repetitive and predictable. But he said that something always goes wrong to sour the jobs he's had in the past and now, again, something is going wrong at SII. This time, it has to do with another employee named Doug Auble. I haven't heard yet why Mr. Auble is ruining Darius' job. But I get the impression that Darius is a man for whom insignificant events can take on enormous importance--he seems somewhat obsessive. He sweats profusely and apologized for it. I should check his thyroid and perhaps be alert for the possibility that he's having a reaction to a legal or illegal drug. He gave me the impression of someone who is abusing methamphetamine, although I could easily be mistaken--I saw no pupilary dilation, for example. Perhaps his hyper manner can be more appropriately ascribed to a personality disorder. There's someone whom Darius calls "Fat Jill" which he is a bit reluctant to talk about. Apparently, she was a romantic interest for a number of years and was also involved in the comedy scene. While he quotes her frequently and with approval, he also expressed a virtual horror at the prospect of being reunited with her.
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Monday, October 12, 1998
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3 pm. Second Session with Darius Booth. I learned a little more about Darius during this session, but I must say he is still something of an enigma. He has the clear tendency to view reality through a distorted lens which magnifies some tiny fragments and ignores the whole. He seems negatively obsessed with his co-worker Doug. Darius told of a particularly illuminating example. Doug apparently has a dermatological problem, and Darius anonymously left a pamphlet from a dermatologist on Doug's desk. Doug took the pamphlet and left it in his in-box for a number of days. Darius was provoked beyond measure--rebuked continuously by the pamphlet's presence where anyone could see it. Darius felt the pamphlet was left there intentionally to cause him suffering, and finally, he removed the pamphlet when he couldn't take it any further. Darius also described a performance at The Cha-Cha. He had a five minute set after another popular but crude comic. Darius' routine sounds excessively intellectual. He said his first minute is spent in a comic pantomime of evolution. When he said it during the session, I was trying to think of why that seemed familiar. After the session, I remembered Alan Arkin's routine in the movie "Simon." I remembered the bit as very funny, so perhaps that's where Darius is trying to head with his work. There was one moment in Darius' routine where he actually got a laugh--exactly one. Darius was so excited that he went to investigate who had laughed. He was unsuccessful in finding the culprit, but he did manage to persuade the manager to give him another chance. Darius has decided not to turn in his elaborate 23 page letter of resignation to SII, mostly as a result of the laugh. We spoke a little about Big Jill, but I still don't know anything about that relationship. But it's apparent that she still has a profound impact on Darius. Darius seemed a little more relaxed until she was mentioned. Then he started to sweat profusely, mopping at his face and neck with a large red handkerchief. Later, when she was mentioned again, I saw a second, small, neatly folded white handkerchief come out as well.
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Monday, October 19, 1998
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3 pm. Third Session with Darius Booth. I'm beginning to believe that Darius' obsession with Doug Arable is not as harmless as it may appear. This is a pattern with Darius: to latch onto some other employee and then to view all their actions as infinitely subtle putdowns or misdeeds aimed at him. Unfortunately, Darius seems capable of seeking a real revenge, he described one although it was so subtle itself that I'm sure that the victim wasn't even aware of it. I believe that I'm ready to make a tentative diagnosis: Darius is suffering from delusional disorder with persecutory features. His delusion is well-systematized, nonbizarre, and accompanied by affect appropriate to the delusion. Darius' personality is relatively well-preserved, and functioning is not markedly impaired. There is an absence of disorganized speech or behavior, or hallucinations. I don't believe that there are underlying mass lesions provoking Darius' delusions, so I'm not going to order CT scans and the like, although I would like a blood test to rule out any metabolic or endocrine disorders--which I think are quite unlikely. The important differential diagnosis would involve schizophrenia or paranoid personality, but I haven't seen any of the psychotic symptoms which each of those would suggest. Unfortunately, the recent literature seems to indicate that delusional disorder responds poorly to antipsychotic medications, although somatic treatment sometimes helps reduce the anxiety which often surrounds the delusion. I think I'm going to have to embark on talk therapy where I neither condemn nor collude in Darius' delusions. After I gain his trust, I'll have to gently challenge his beliefs and show how they interfere with his life. Insight-oriented psychotherapy is not generally recommended for delusional patients.
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Monday, November 2, 1998
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3 pm. Fourth Session with Darius Booth. Darius demonstrated a certain emotional lability by swinging to an exuberant high today. He was ecstatic because he's been offered an undefined job at The Cha-Cha. He got the job by hanging out in the bar, upsetting the manager periodically by asking to see the owner. He had nothing particular to say to the owner, but he liked the strong reaction his request elicited from the manager. At last, after begging him to leave, the manager introduced him briefly to the owner--a small woman buried under an ocean of paperwork--and then offered Darius a job. Darius accepted and is ready to quit SII even though he has no idea what job he has been offered.
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Darius Booth's Patient File
