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Saturday, April 26, 1997 |
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Sunday, April 27, 1997 |
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Monday, April 28, 1997 |
4 pm. Second Session with Katherine Lippard. Katherine is a bit of an enigma. I get the strong sense that there is something else that she wants to tell me, but she is so closely guarded that she won't let herself open up. I believe that she wished me to continue our sessions together, but I decided to force the issue and see whether I could get her to admit why she had come to seek my assistance. But it didn't work, at least not right away. When I told her that she hadn't given me any reason to believe that she should continue therapy, she struggled with herself for a long time before she answered. I'd hoped that she would say something like: "Well, I haven't told you everything, Doctor," or some such. Instead, I got Katherine: the brusque business woman. At one point during the session, when she described her need to be organized as "pathological" she smiled and it seemed to me that she was half joking. It came as a surprise because her demeanor is otherwise so matter-of-fact--as if humor doesn't have a place in her ordered existence. And there is a significant man named Philip in her life, who I assume is her boyfriend. But she was completely unwilling to discuss him. She was sorry that she had even even alerted me to his existence by mentioning him in passing. I'm not sure why it was so important to her to avoid telling me about him. I sense it would go against her own inner sense of corporate purpose to admit to the frivolity of a romantic relationship--but maybe she was just trying to stay on track--only divulging what she thought important to my diagnosis. I still believe that Katherine suffers from Obsessive Compulsive Personality Disorder, but it is a mild form, and in my experience, mild cases are not generally amenable to treatment. I hope I see Katherine again and she allows us to delve a little deeper under her corporate facade. I wouldn't be surprised to find strong feelings of inadequacy, for example, which she has tried to mask with a personality projecting super competence. 6:06 pm. Telephone Call from Decker Jenkins. Decker called in and apologized for missing his session on Thursday. He delayed beginning with the risperidone that I prescribed until just a few days ago because he was battling with Simian about a possible euphoric effect, but now he is disappointed because he doesn't feel any different. I advised him that it would take several weeks for the medication to take effect, and he seemed to accept that. Decker seemed calmer and more focused during this conversation than in our earlier sessions. Some people find it easier to concentrate on a conversation on the telephone rather than face-to-face because the telephone only involves one sensory input--sound--as opposed to the cacophony of impressions one gains in person. But I also sensed that Decker seemed less skittish somehow, and I'm not willing to ascribe it all to the telephone effect. Perhaps he got a good night's sleep. And Decker actually gave a ghoulish sort of chuckle when he joked about not killing himself yet. It surprised me that he could show that kind of perspective on his situation, although I have to say that I didn't find his joke very funny. I'm still planning on conducting a suicide assessment during our next session. Decker is getting some support from his employer, Mr. Knopff, who recommended that Decker seek my help. I'm very glad that Mr. Knopff has recognized this problem in his employee and, instead of just firing Decker, is actually helping him to get some medical attention. So often in these cases, employers decide just to terminate an employee rather than get involved. |
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Tuesday, April 29, 1997 |
12 pm. Ninth Session with Eliza Raven. In a series of bizarre coincidences, Eliza hooked up separately at her concert with two of my other patients, Peter Hossfeld and Christina Herald. Christina came as Malcolm's girlfriend. Apparently, Eliza's best friend was Camille--the spiky-haired lead guitar player who was elaborately pierced in every conceivable place. Camille had a relationship with Malcolm. Now Camille is claiming to be three months pregnant with Malcolm's child, and she dropped this bombshell on him after the concert on Friday, in Christina's presence. Malcolm's reaction was ugly enough to inspire Luke to call the police, who took Malcolm away in handcuffs. In the tumult, Camille inflicted a blow to Eliza's face which is still visible. Anyway, after the concert, Eliza made contact with Peter Hossfeld, with whom she sensed a psychic connection. She said that she thinks he was the one with whom she had a romantic involvement on the astral plane. Eliza talks about Peter with all the enthusiasm of a preteen girl who has a crush. Peter, in the meantime, seems to think that Eliza is the sorceress with whom he needs to make his peace in order to remove the curse which dogs him through each reincarnation. So Eliza and Peter went off to some all-night coffeehouse and talked. Meanwhile, Camille and Luke went back to Luke's mother's house and ended up in bed with each other, after taking some incriminating Polaroids. When Eliza got there (and Luke must have known the terrible risk that he took having sex with Camille when Eliza was due back), she found the two of them, completely naked and uncovered, in obvious flagrante delicto, although now asleep. Without waking them, she took some additional Polaroids of the pair which she showed to me. Suffice it to say that the pictures left no doubt as to the sexual nature of their encounter--several of the pictures were closeups of their genitalia--Camille with her labia pierced several times and Luke still partially wearing a condom. Eliza began our session by pretending to be completely unemotional about the whole situation, but soon she found herself feeling strong anger--unfortunately directed mostly at herself, as if she were responsible for the decisions of Luke and Camille. I tried to redirect that anger outward and think I achieved a fair degree of success. But Eliza hasn't indicated to anyone else that she is aware of Luke's infidelity. She is waiting to see if Luke will spontaneously confess, or whether she will have to use the pictures to counter his denials after she begins to hear rumors--she doesn't believe that Camille will be able to keep the encounter a secret. Eliza also said that Malcolm's girlfriend, Christina, was left somewhat shaken by the night's events. Eliza gave her e-mail address to Christina so that she could fill her in on Malcolm. Looks like Christina will be in particular need of my assistance on Thursday. 4 pm. Thirty-Seventh Session with Sylvia Bows. Sylvia went back to SII and met with a wave of awed silence and gossipy whispering. She saw Lloyd, who made an elaborate point out of being very nice to her. Sylvia wishes to return to work at SII part-time for a month and then start full-time beginning in June. Lloyd had no problem with that and vowed to help her transition back into her position. He even made a joke out of the recent controversy surrounding Sylvia, telling her that he'd find some way to take advantage of all her publicity. Lloyd shocked Sylvia by telling her that he was considering making a play for Apple Computer. It would be the story of Jonah swallowing the whale. Apple has at least eight times the annual gross sales of SII, but anything is possible these days with leveraged buyouts and the magic of investment bankers. Sylvia believes Lloyd is interested in the acquisition because it would thrust him into the public eye--she seconded my non-professional opinion that he was a megalomaniac. Anyway, Sylvia then went back to her department where she was accorded a warm reception. Nils Landor took her back to what used to be her office for a chat. Nils was trying to ingratiate himself with Sylvia and he apologized for being used as a pawn, as he put it, in a game between Lloyd and Richard. Apparently, the witch-hunt that Nils conducted was done on Lloyd's orders, and Lloyd did it as a favor to Richard. Richard turns out to be a bisexual who has had a relationship with Lloyd sometime in the past. Although now Nils is profuse in his apologies, Sylvia believes that he was a willing participant, trying to smear Sylvia so that he could take her job. But now Nils is jealous of Richard. Nils still believes himself to be Lloyd's boyfriend, so after seeing the information he dug up used in Richard's custody lawsuit, Nils initiated a fist-fight with Richard that cost Nils a broken nose. Sylvia told me that I was the only one to whom she had told this complex story, so I urged her to bring Tom into it. Tom strikes me as a strategic thinker and, of course, Sylvia is no slouch herself. Together, they should be able to come up with an interesting response to their detractors. |
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Wednesday, April 30, 1997 |
Wrote an E-mail response to Peter Hossfeld. I told him it took about 20 minutes to respond to one of his e-mails. So I lied. I'm a wimp. I just felt weird asking Peter for the full amount of my services when he is paying the freight by himself. It's one thing to bill the HMO, and quite another to bill a person in distress. So I'm billing Peter $20 per "session." What a way to get rich--e-mail therapy! I tried to bait Peter a bit by questioning whether certain metaphysical statements were actually suicidal longings and by urging him to consider checking into a mental hospital. In some ways, a voluntary "involuntary" commitment makes sense for Peter. It would free him from the influence of Serena, and he would have a plausible way to end the relationship without blame. The rest of my letter was primarily an attempt to continually challenge Peter to think logically about his situation. I feel that the best I can do with Peter through e-mail is to keep challenging him to stay rational. So I am much more confrontational and abrasive in writing than I would be with a patient who I was seeing in person. |
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Thursday, May 1, 1997 |
10 am. Third Session with Decker Jenkins. While I can't call the risperidone trial a success yet, I have noticed a significant change in Decker's affect. While still physically sitting on his hands, he is smiling and joking now, looking me in the eye and quite a bit more relaxed. When he swears, he no longer looks frightened, as if he's going to be punished. When he spoke of Karen--his mother--he was able to actually make a joke, where as before he could express nothing but anger and fear. I was surprised to find the extent of Decker's inexperience with women. He is still a virgin--although I presume as a bartender that he has had many opportunities--and his view of women has been completely colored by the horrendous relationship he had with his own mother. Decker is a misogynist, but he got that way mostly through fear of and a lack of emotional contact with women. He assumes that they are all versions of Karen. Except for one woman who he met last week--Christina. By the weirdest coincidence, this is the second time in a week that one of my patients has become romantically interested in one of my other patients, and neither of them involve contacts through SII. Decker told me about this girl who came into the bar and won his heart by ordering a double bock, which they didn't have. I remembered Christina Herald telling me how disappointed she was that some bar didn't have double bock. He then floored me by saying that her name was Chris. She talked to him in a friendly way at the bar, but I assume she has no idea of the conquest she's made. I conducted a suicide assessment of Decker and find that he is not a current suicide risk, although he clearly has latent tendencies which could become suicidal if untreated. Decker told me that he has held a loaded gun to his head at some time in the past, but decided not to pull the trigger because of the thought that the act would not free him of Simian, who would just follow him into the afterlife. Decker thinks of Simian as both a kind of devil and as the source of his courage. I'm concerned that some part of Decker will miss Simian if we are able to control the auditory hallucinations through the anti-psychotics. I asked Decker to try to keep a daily journal. I think it would be especially useful to him later when he is evaluating the progress he's made. And I told Decker that I respected him for realizing that he needed help and taking the steps that he has to get it. It must not have been easy for him. In fact, I can't think of another schizophrenic I've treated who wasn't brought in by someone else. They usually don't come in by themselves. But Decker doesn't believe he deserves the credit. He gives it instead to Simian, who he says urged him to get help from me. I told Decker that we would work together on his goals, which are to move out of his mother's house, have a real friend--someone he can invite to a baseball game and, I presume, having an intimate relationship with a woman who doesn't savage him. 12 pm. Eighth Session with Christina Herald. Christina thinks of herself as completely invulnerable, and yet she has found herself shaken by circumstances that were clearly beyond her control. Her flirtation with her dark side, through "bad boy" Malcolm, has injured her pride, I think, more than anything else. Christina went with Malcolm and Jonny to the rock concert that Eliza's group put on Friday night. As Eliza told me during her last session, Malcolm and Camille--the "underage chit" as Christina calls her when she's being charitable--had their fight and Malcolm was arrested and taken away in handcuffs. Christina went back to the apartment of one of the band members--Anders--and got quite drunk. She passed out there until two the following afternoon. When she finally got home, she had to comfort her terrified grandmother, who'd assumed that she had been murdered by Malcolm. The members of the band, including Eliza, told Christina a lot of information about Malcolm, and all of it was quite unpleasant. Malcolm believes that he now owns Christina--the ring which he gave to her is a sign of his ownership and she is not free to return it to him of her own accord. And Eliza, now communicating with Christina via e-mail, told her that Malcolm was a suspect in the murder of his fiancée in New York, who was apparently found with her neck broken on the floor of her parent's living room. And, so the story goes, the prospective father-in-law was extremely rich and believed that Malcolm had committed the crime. Malcolm fled New York, but told Eliza that he was innocent and that the girl's father had Mafia connections which had actually committed the crime. I find this story almost impossible to believe. Malcolm now sports far too high a profile to be a fugitive. And, if the father was really as wealthy as all that, he would have supplemented the police's efforts in locating Malcolm and extraditing him back to New York. Furthermore, how would Eliza and her group have all this information? Would he have volunteered it? Did they know him from his New York days?--hardly consistent with a fugitive cutting his ties with his past. Hiding in California from troubles in New York is not a very effective means of eluding authorities. Most of the people here seem to be ex-New Yorkers--like me. I suspect that Malcolm is burnishing his image by carefully creating a colorful persona. And Christina seems to find the dark side of him to be his most attractive feature. I'm not sure that if he was the computer science college graduate he is supposed to actually be, that she would find him particularly appealing. She seems all too eager to believe, to be thrilled by and then to forgive him his past. At one point during the session, Christina cried, although she quickly recovered and brought herself firmly under control. It was quite a contrast to her usual cheerfully tough attitude, and revealed quite a bit of the vulnerability that I know she has been feeling, but which she normally cloaks under her arrogant good cheer. 4 pm. Fortieth Session with Anna Green. I hope I didn't cross the line, but Anna was feeling so dejected after her S&M encounter that I felt that I had to reach her on a personal level perhaps overstepping my role as her therapist. Anna experienced something that I've heard referred to by S&M adherents as the "morning after" effect. It's a delayed depression which could start sometimes months after a person's first S&M encounter. Usually, it's characterized by a severe sense of guilt--experienced by both dominants and submissives--shame and feelings of worthlessness. A woman who has allowing herself to be treated as a submissive often feels that she has violated a great many societal taboos. She may feel that she has betrayed her sex and also some part of herself as a person. Usually, these feelings resolve themselves, although some people worry about it for years especially if they stay within the S&M community and continue to practice. The strong emotional responses that S&M undeniably coaxes from its practitioners can be very difficult to integrate into a person's world view. And there is a conflict--on one hand there is the strong sexual and emotional response and on the other is the knowledge that the act is unacceptable to the community they live in and sometimes to the individual's sense of self. I worked with Anna and tried to explore her feelings on this subject. She told me that she felt shamed and somehow branded--as if every stranger on the street knew that she was inferior, so that she had to step aside as she walked the street, ceding the right of way to those around her. And now she's suffering from sleeping difficulties, having bad dreams--she told me one which was just an image of being with her mother while realizing that they had both just eaten contaminated meat--and awaking frequently. She's also feeling dirty and unclean. I presume that she didn't sleep well in anticipation of her session with Gray, and that afterwards, she has been suffering from pain caused by him and by the car accident. So I assume that sleep deprivation combined with her breaking up with a man she really liked has contributed to her depression. I urged her to start taking melatonin again, which seemed to work well for her before. If her sleep doesn't improve by next week, I'll consider a short-term prescription to aid her sleep. And finally, I suggested that she go spend time with her parents. She always seems to find her emotional center with them. |
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Friday, May 2, 1997 |
My service reported that they got a telephone call from Katherine Lippard late last night. She sounded anxious and upset. They thought that she might have been drinking. I tried calling her then at home, but I wasn't able to reach her. I tried again this morning at her work, but they told me that she wasn't expected in all day today. I'll keep trying her over the weekend. 11 am. Tenth Session with Cassandra Evans. Cassie started the session by telling me just how miserable she felt. This was the first session we've had in nearly half a year, and while there have been many changes in the external circumstances of her life, many things have remained the same. Her feelings of frustration and anger over her affliction--Chronic Fatigue and Immune Dysfunction Syndrome--are as deep as ever. Cassie hates being sick and having so little control over her life. She doesn't know day to day if she will feel well enough to get out of bed in the morning. Cassie is also frustrated by the lack of treatments available to her. The medical community has little to offer her and the self-help options found in popular magazines and books are questionable, to say the least. Cassie described one with derision that recommended a concoction made of bananas, carrots, and linseed oil. Cassie wanted to spend the session analyzing a disturbing dream that she thought might hold some key to her psyche. The dream had her inflicting great violence on a white rat, which she associated with the prying busybodies who ask her ceaseless medical questions. Cassie constantly has to deal with people who feel that her condition is a sham. I was at a dinner party recently and a man told me, with a knowing wink, that his shiftless brother-in-law had told him that he was suffering from chronic fatigue syndrome. I thought of poor Cassie as I told the guy about the very real medical problems faced by those inflicted with CFIDS. At the end of our session, Cassie grew pale and was clearly too tired to continue. So I let her rest on my couch with the lights dimmed low while waiting for her ride home. 4 pm. Eighth Session with Thomas Darden. We explored Thomas' agoraphobia during this session. He has an adverse physical reaction towards confronting unfamiliar people in crowded situations, expressing itself in panic attacks. He reports a nauseated feeling immediately prior to being thrust into a crowded social situation, only partly relieved by being with people he knows. Thomas feels the most panicky when he believes that he will be singled out for attention by the crowd. Thomas' agoraphobia might be related more to social situations than it is to crowds, and might more properly be diagnosed as a specific phobia connected with panic disorder. I'm still not sure if the panicky feeling is triggered by a fear of being embarrassed or whether it is more akin to claustrophobia. In any case, I should be alert to the possibility that Thomas' alcohol abuse may be in part an attempt at self-medication designed to alleviate unpleasant symptoms. A common complication in similar cases is significiant depression, which effects almost 50% of those afflicted. I feel that the best treatment is still gentle encouragement to enter feared situations. However, if that is not producing results, antidepressant medications, especially the tricyclics and the serotonin reuptake inhibitors have been shown to be effective in the treatment of panic and agoraphobia. And I should tell Thomas to eliminate the intake of caffeine, although computer professionals seem to be highly resistant to this advice. Although somewhat irrelevant to Thomas' situation, he told me a story about a woman in his department, Doris Meckle, who was passed over in a promotion in preference to a male employee who was apparently better liked, and she filed a sexual discrimination complaint within the company. The promotion, which had already been handed out to Thomas' friend Rob, is now apparently being reconsidered. If Rob loses his promotion, he has threatened to file a complaint for age discrimination. So it is a duel of the discrimination complaints. The atmosphere in the Help Desk does seem charged. I received an e-mail from Peter Hossfeld. Peter is so caught up with psychic phenomenon that he hasn't recognized a genuine scientifically unexplainable phenomenon that has struck him like a lightening bolt. Peter has experienced "Love at First Sight." I've seen it happen before, and it always floors me. Here, it hit him rather hard and seems to have affected Eliza in much the same way. Peter is trying to explain it by believing Eliza to be the sorceress which fulfills Serena's prophecy, but to tell the truth, I was always expecting the sorceress to turn out to be Serena herself (surprise, surprise), although I believe that Serena, too, will be in for a surprise when Peter tells her that he's located the sorceress in the person of Eliza. I suspect that Serena will dispute Eliza's claim to the throne. Peter has undergone a fairly remarkable transformation in just a few short hours due to his new surge of interest in this life--and Eliza. Love is making him strong. I think that she can do a world of good for him in ways that I have failed. If anyone is going to free Peter from the bondage that he's experiencing with Serena, it's Eliza. Even if the relationship doesn't work out between Eliza and Peter in the long run, in the short run it may win Peter his freedom and his health, if he can get some genuine medical treatment. Somehow, I don't see Eliza as supportive of artificially inducing epileptic seizures. When their relationship becomes more intimate and they tell each other of their therapists, I am sure they'll be surprised to discover that they are both seeing me. I'll have to be careful to keep a wall between things I've learned from Peter and things I've learned from Eliza when talking to each of them. Basically, I have an ethical problem, but now is not the time to try to resolve it. |
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Charles Balis' Personal Diary & Log