Saturday, September 20, 1997
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Sunday, September 21, 1997
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Monday, September 22, 1997
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9 am. I received a fax from the Anonymous Faxer. This one shows a logjam of old-fashioned street cars, all marked as part of the F Castro line. Once you get on a streetcar, you don't have a choice of destination. All cars lead to the Castro--representative of the openly gay lifestyle that draws the Anonymous Faxer. But are they stuck? This image evokes a sense of an impediment blocking the Anonymous Faxer.
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Tuesday, September 23, 1997
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1 pm. First Session with Rachel Tanner. Rachel is 21 years old. She's slightly overweight but attractive. She seems to dress a bit young for her age--she had a stripped shirt and baggy pants. She had deep circles under her eyes--I assume that's from lack of sleep. Rachel was constantly using her left hand to scoop her long henna brown hair over her left ear. Her hair was probably once extremely attractive, but it's now clearly thinning as her grandmother described. I could see that she was trying to cover up some of the thinning problems by using her bangs and a barrette. I've seen that type of hair loss in several of my OCD patients in New York. Usually, it's the result of obsessive over-brushing. My suspicions were confirmed by Rachel during the session. Rachel counts things--she counts the number of brush strokes. But she can't stop until she does a set number of strokes. If she's interrupted or miscounts, she has to start brushing all over again. The hair loss is a result. I also noticed that she constantly picks her nails--first, she pushes the cuticles of one hand with the fingernails of the other, and then she cleans her nails by digging the nail of one finger under a nail on the opposite hand. She always starts with her thumb, then moves on to the middle, and so on until she's finished with that hand. If I'd asked her to stop, I'm pretty sure she would not have been able to. And yet Rachel is very self conscious. When she first came in, she had trouble relaxing enough to sit down. Rachel told me that she was worried that I just wouldn't understand her and label her crazy. She said that she believed that her grandmother probably thinks that she is crazy, and that's why she'd contacted me to try and help her granddaughter. Rachel described an incident when she was unable to leave the shower for three hours. She has a certain order to washing her body, and if she makes a mistake she would have to start from the beginning. The problem is that the order changes from week to week and Rachel just couldn't remember how do it right. After some time, her grandmother got scared and started to pound on the bathroom door. Now, she times Rachel's showers and after ten minutes shuts off the water. Halfway through our session, I mentioned Obsessive-Compulsive Disorder or OCD. I just wanted to know if she ever heard of it. But Rachel jumped at this diagnosis right away. It was clear that she needed something to help her understand her own behavior and the constant need to do things. She even went as far as diagnose her own mother with the same affliction. Rachel's mother died three years ago in a car accident. Rachel believes that it might have been a suicide--the day of the accident she didn't follow her standard routine. I asked Rachel to describe some of her mother's obsessions. Apparently, Rachel's mother had to check things--the doors, the stove, the lights, etc. Her obsessions mainly involved safety issues. But Rachel's obsessions are different, and she recognizes that. Rachel's are mostly about personal hygiene. She said that she first started experiencing these symptoms after her mother's death. She describes her rituals as "being good." They are the retribution for being "bad" when her mother was alive. But being bad, as Rachel describes it, was really just a child's way of coping with living with an OCD mother. Rachel talked about not dusting well and not really cleaning her room right--things that most kids do anyway. But now, Rachel feels that she has to pay for those childish misdeeds. She punishes herself for her mother's death even though she understands that it's not a logical thing to do. When she discussed her mother's death, she began to cry, but was able to stop, although her face plainly reflected her sadness and grief which were mixed with her fatigue. Rachel does have typical symptoms of OCD, but I am hesitant to begin a somatic treatment until I have a chance to get to know her better.
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Wednesday, September 24, 1997
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4 pm. Nineteenth Session with Katherine Lippard. We spent most of our session today talking about love. I told Katherine about a study conducted a few years back that compared the brain chemistry and neuro-activity of a person in love with a psychotic. The study showed that there were a lot of similarities in the types and amounts of the chemicals present in the brain tissues of both subjects. But unlike the subjects experiencing psychosis, the brains of the individuals in love went back to normal after some initial period of time--the initial rush of emotions and feelings in the beginning of the relationship. For the last months or so, Katherine was feeling a sense of dissatisfaction with her relationship with Jake. It wasn't anything that she could put her finger on, although she tried to analyze her feelings for him. By telling her about the love study, I was hoping to give Katherine a way of reasoning about her feelings. If what she's been feeling is the lack of the original overwhelming passion for Jake, then perhaps that stage of their relationship was over. Katherine is very inexperienced when it comes to long-term romantic relationships--she's never had any. It was quite possible that she just never experienced what it was like after the rush of feelings was gone and the more comfortable and relaxed period of the relationship started. But as I suspected, what Katherine was feeling was more than just the lack of "giddiness and goose bumps." During our conversation, Katherine realized herself that the problem was that while she loved Jake, she was not in love with him. That's exactly what Jake told her a while ago--he felt the same way. I asked Katherine what this realization meant to her as far as her relationship with Jake. She told me that there's a lot more to be learned about him and, at this point in time, she doesn't know if he's "the one." Katherine also told me that Frank, her boss, managed to secure the support of SII's Board of Directors for her nomination as the next CFO of SII. Surprisingly, Katherine didn't seem as thrilled by that as I would have thought she would be. She said that she's not sure anymore that's what she wants. Katherine is also going to the East Coast to see her family. She's preparing a list of issues that she wants to discuss with her mother. She said that she'll bring her list in, and we'll go over it together before she leaves.
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Thursday, September 25, 1997
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4 pm. Fifty-Seventh Session with Anna Green. Screwed up another life, just another day as a psychiatrist. Anna has consummated her three-way relationship and she couldn't be happier, she says. And she tells me that it's all due to me. She thanked me for giving her the freedom to be able to make the choices that she's made. Somewhere inside, I kept hoping that Anna would decide that she wasn't interested in a three-way relationship, but I was fooling myself. Anna is easily led into sexual situations which she doesn't truly desire. She has the ability to convince herself in retrospect that it was all her idea. It's as if Anna soaks up the desires of those around her and turns them into her own desires. She bubbled about how happy she was and the terrific honeymoon that the three of them had in some hotel up the coast, and I suddenly got a splitting headache. I just had to end the session early.
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Friday, September 26, 1997
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4 pm. Nineteenth Session with Thomas Darden. I started our sessions by inquiring about the company trip Thomas was supposed to go in the near future. I think it would be good for Tom to overcome his anxieties and go and try to have a good time. He won't, of course, but perhaps he'll realize that there's little to be afraid of in such a situation. But Tom used my opening to slip in the fact that he has been seeing a woman for the past couple of months. Her name is Karina, and they've met over the Internet. Tom is very self-conscious that they met this way, and he told me that Karina instructed him never to tell anyone about it either. Tom believes there is a negative stigma attached by society to relationships that start online. I think he may be right. Karina was the one who approached Tom through a personal description in the AOL's members guide or something. Tom quickly denied still having this AOL account--I think he might believe that there's a stigma attached to that as well--self-respecting technowizs don't access the Internet via AOL or something. It's funny that I'm able to recognize this fact--must be due to a year of dealing with the employees of a large computer company--some of the culture seeps in. What Tom wanted to talk about was his frustration with his own inability to function within a relationship. While Karina made overtures toward romantic involvement at first, their relationship quickly moved toward the platonic. Tom told me that Karina just broke-up with a boyfriend of many years and didn't really wanted to get seriously involved with anyone yet. But Tom prefers to think that Karina's lack of sexual interest in him is purely due to his own inadequacies. He told me that he believes that Karina just uses him for his computer expertise and help that a friend could offer (like helping unpack). He said that she believes him to have only half a brain and no feelings that she could hurt by acting so cold. But from what Tom was telling me, I saw a completely different picture--a woman still emotionally fragile after an unsuccessful relationship searched for a kindred spirit via the Internet. Not wanting to be hurt again, she asked Tom for his friendship but not a romantic involvement. She sought out Tom's company by coming up with excuses to be around him--borrowing the use of his computer, asking for his help with the move, etc. But because of Tom's low self esteem, he views reality through a filter that makes him interpret every event and motivation as due to his personal failings and inadequacies. He told me that he tried to break off his friendship with Karina by writing her a painful e-mail message. But she refused to stop seeing him. Then he got drunk and called her in the middle of the night. He only half remembers that conversation but believes it was bad. Tom is trying very hard to sabotage his own happiness. I advised him to try and call this woman again and to try and restore their friendship. I'm also bothered by the fact that Tom seems to be drinking a lot. He was drunk when he made that stupid phone call to Karina. He was drunk when he called me a few weeks ago. And from what glimpses I have into his life, I think Tom might me getting drunk on very regular basis. I think we need to talk about it again. Perhaps it is going beyond a desire to self-medicate and really reflects an underlying alcoholism problem.
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Charles Balis' Personal Diary & Log