Saturday, August 15, 1998
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Sunday, August 16, 1998
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Monday, August 17, 1998
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12 pm. Thirtieth Session with Thomas Darden. I had a very disturbing session with Thomas Darden today. He surprised me by describing a set of non specific, non persecutory auditory hallucinations. These hallucinations have apparently been going on for some time, although they have gotten stronger since Tom began the Prozac. I went through the literature and was unable to find any specific references to Prozac-induced hallucinations. Furthermore, Tom reports that these hallucinations are long-standing, although perhaps they didn't previously have the same frequency or intensity as they have now while Tom is taking Prozac. The auditory hallucinations are causally linked to nightmares, although they are not related to the subject matter of the dreams. The nightmares all end with a terrifying moment that seems mostly inspired by some trivial event in the dream. The terrifying moment ends in a burst of adrenaline. He feels pressure at the base of his skull, a tingling down his neck, and then he begins to hear an unintelligible jumble of voices, all strung together, all speaking rapidly and urgently. Tom is captivated by that part. He believes that he's somehow broken through a form of dimensional rift and has made contact with beings from somewhere else. Tom said that he can sometimes reproduce the adrenaline rush portion of the nightmares even while awake, although he can't summon the voices. Tom also described some other recent disorientations which he believes are caused by Prozac. These include dizziness and feeling faint. Given the above, I decided to discontinue the Prozac trial. Obviously, in light of the psychotic nature of the auditory hallucination, I first thought of insidious-onset prodromal schizophrenia, or a schizophreniform disorder. Schizophrenia is characterized by both negative and positive symptoms. While the auditory hallucinations can be a marker, I didn't think Tom exhibited signs of the other positive symptoms which, broadly, are delusions, bizarre behavior, and positive formal thought disorder. Unless I stretch Tom's asociality, he doesn't seem to possess the negative symptoms--affective flattening, alogia, avolition-apathy, anhedonia-asociality, attention. Furthermore, I've always considered schizophrenia to be a diagnosis of exclusion, especially in light of the relative severity and limited scope of the treatment options. There's no evidence to tie these events to a bipolar condition, and I haven't noticed bipolar tendencies in Tom. I'd like Tom to undergo a thorough physical to rule out temporal lobe epilepsy particularly, but also tumor, stroke or other brain injury; endocrine or metabolic disorders (especially porphyria exacerbated by chronic alcoholism); or drug abuse or the effects of alcohol withdrawal. I am not prepared to make a diagnosis, although I'm leaning towards the conclusion that Tom is suffering from an atypical case of unspecified delusional disorder. Delusional disorders require that the delusion is non-bizarre although false (the delusion that one is being deceived by a lover is common). Tom's belief that the voices come from another dimension would usually be considered bizarre. But Tom is trying to explain the source of voices which clearly don't have a terrestrial source. His attempt to explain them through science fiction rather than resorting to radio transmitters planted in his head or thought control exercised by another seems almost reasonable under the circumstances. Otherwise, except for his social awkwardness, Tom is high functioning and not markedly impaired and he has none of the disorganized speech or behavior or other negative symptoms of schizophrenia. However, since Tom reported that the Prozac had increased the frequency and intensity of the delusion, I want to make sure that this isn't a side effect of Tom's tendency to mix Prozac with substantial alcohol consumption. So I asked Tom to discontinue the Prozac and wait a week and then begin a six week trial of Zoloft, 20 mg. q.d. upon awakening.
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Tuesday, August 18, 1998
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12 pm. Second Session with Madeline Trent. This session was primarily for the purpose of giving Madeline permission to relax. If she thinks it's good for Natalie, she's willing to indulge herself with activities designed to relax her. But otherwise, she feels too guilt-ridden to allow herself to really relax, which I've found to be common among new mothers. Madeline said that she relaxes with manicures, pedicures, and scented candles. Although those wouldn't work for me, I encouraged her to take time to do those things on the pretext that Natalie would benefit from her mother's increased sense of well-being. I still felt that Madeline is keeping me at bay somewhat--she's struggling to feel comfortable in a therapeutic setting. So I'm not pressing as hard as I might, even though we clearly haven't established a close enough relationship to enable me to do much good. She did tell me that Jesse makes her laugh, and for the first time, I got some intimation that she really does love her husband.
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Wednesday, August 19, 1998
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2 pm. Fourth Session with Kelly Wiseling. Kelly told me that she has a crush on Thomas Darden. The irony is that she's too afraid of rejection to make the first move. I'm in a tricky situation because I can't really push Kelly to begin an involvement with Tom and I can't really push Tom to begin an involvement with Kelly. We talked about Kelly's sexual history. During high school, she had a two year relationship with a hearing boy named Daryl whom she didn't really like. She described him as sexually insensitive and mostly interested in gaining brownie points by dating a deaf girl. When he went out of state for college, they broke up, much to Kelly's relief. She didn't date much at Gallaudet, but she did enter into a relationship with a boy named Peter. Although they were friends, Peter wasn't really a love object. But Kelly was able to enjoy and explore her sexuality with him. Kelly was interested in sexual experimentation, but Peter was apparently threatened by Kelly's sexual demands. He called Kelly a nymphomaniac and told a number of his friends intimate details about their sex life, and Kelly felt betrayed. It was her impression that her reputation was tarnished as a result--she felt that she became the butt of jokes and that everyone at the school thought she was a whore. After college, at DeafTech, she went out with someone a few times, but she feels that she was still too defensive from her experience with Peter to accept that relationship. Now she's waffling on whether to initiate a relationship or not. She'd clearly like the affection and sexual contact, but she sometimes doesn't feel that a relationship is worth the emotional investment. One thing that Kelly said particularly struck me. She said that she went out with Daryl even though she didn't like him because that was what her mother wanted her to do and "it takes too much energy to fight my mother." Kelly told me a bit more about the deaf community. She explained that there are many in the community who do not welcome hearing people's attempt to join, even when those people are working as teachers and interpreters for the deaf. She's one of four women living together--three of them are deaf and there is one hearing woman who's studying to become an interpreter. Kelly likes the interpreter, but the other roommates shun her and denigrate Kelly for associating with her. Our conversation led to a discussion of the hearing actress, Stacy Edwards, and her portrayal of a deaf woman in the movie "In the Company of Men." Although Kelly thought the performance was both sensitive and accurate, she said that many in the deaf community were outraged because the deaf character wasn't portrayed by a deaf actress.
5 pm. Fifty-Ninth Session with Alex Rozzi. Alex had a tough week which culminated in being stalked and then assaulted by Regina. Alex's story, greatly simplified, was that he was leaving a pharmacy with prescriptions for Ralph when Regina suddenly surprised him, punching him in the face. Alex fell backwards, clutching a rack of merchandise which also spilled. Regina threw some liquid on Alex and then lit a match, saying, "If this was gasoline, I'd be able to light you on fire right now." Fortunately, the liquid wasn't gasoline. Alex got up and chased Regina out into the street where she was knocked to the ground by a passing car. The police came and the eyewitnesses differed in their stories. One thought Alex had pushed Regina, while another said that she had tried to light Alex on fire. Just then, Alex saw Ralph's car, which he had been driving without a license, loaded on a tow truck. He started to chase the tow truck and the police thought he was trying to escape. So Alex was handcuffed and taken in for questioning. Fortunately, Alex was able to enlist the help of Cecil, the lawyer who represented him during Benny's trial. Eventually, Alex was released without being arrested or charged. Regina, on the other hand, was charged with assault and mayhem. Ralph pointed out that the fact that Regina has been arrested for stalking Alex will put a damper on her lawsuit against him. Alex has been having bad dreams where he is set afire by Regina. Such dreams seem well motivated, actually, given the circumstances. Ralph is doing better, having conquered his nausea. But he's been sad following the death of an elderly mentor. Alex told me a ghost story about going over to the mentor's house prior to the funeral and witnessing bumps and ringing alarm clocks and flushing toilets all of which Alex attributes to supernatural causes. Alex also told me that Tony and Sharon have broken up. Sharon just stopped coming or calling. Tony is apparently quite broken up by the split. Alex says that Tony stopped eating or responding--Alex had to break into his house to find Tony in a fetal position, mostly unresponsive, and clearly showing the signs of having spent the day weeping.
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Thursday, August 20, 1998
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4 pm. Ninety-First Session with Anna Green. Anna had a long conversation with Martin about their relationship. Although I don't trust his motives, it seemed to be good for Anna. As Anna sees it, Martin was trying to apologize. That kind of closure is very important to her. She didn't have it with Bill, and when she first came to see me, she was having endless imaginary conversations with him. I think that her opportunity to do a post mortem on her relationship with Martin will diminish her need to obsess about what happened in that relationship later. Anna said that she now understands that it would never have worked out between Martin and herself, even without Kathy's destructive influence. However, I'm not sure she's really internalized that concept and I'm quite sure that she hasn't communicated that thought to Martin. He's working in the Future Technology department of SII on some Brave New World project involving implanting electronic identity tags into employees for the purpose of triggering electronic devices, and opening doors. I hope I don't betray a certain distaste for technology in general by revealing that I instinctively dislike the idea. But Anna would like to work on that project and Martin is holding out the prospect of a transfer to his department like it was a carrot. Anna told me that Martin didn't initiate the post-relationship conversation until after he broke up with his latest girlfriend. I'm not sure what his aim is, but I suspect that it has to do with getting back together with her.
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Friday, August 21, 1998
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10 am. Thirtieth Session with Sharon Lough. Sharon has been asked to testify in a divorce action involving her former landlords. Last November, they wanted to vacate Sharon's unit and falsely accused Sharon of sexually abusing their five year old son. Instead of standing up to the charges, Sharon fled. She was too upset by the allegations, and too concerned about the way her past would make her look in court, to fight the false charges. Now, the mother is trying to limit the visitation rights of the father by making similar sexual abuse charges. Sharon, presumably, is being deposed for the purpose of revealing the mother's predilection for making false sexual abuse allegations. Sharon, however, is predictably upset. She believes that this will raise all the issues of her past which she had hoped to avoid by fleeing the first time. She also doesn't much like the prospect of assisting the father in securing his visitation rights--she thought he was verbally abusive. Sharon's legal problems over her hallucinogenic mold continue. She told me that she is supposed to have a preliminary hearing next month, although she still doesn't know the results of the lab test on whether the particular species of mold she was growing was, in fact, an illegal drug. Sharon is using the relaxation tapes I gave her during our last session. I was afraid that she would dismiss them as new age pablum, but she seems to have given her cynicism a rest and taken them seriously. She reports that she found them effective.
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Charles Balis' Personal Diary & Log