Saturday, November 1, 1997
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Sunday, November 2, 1997
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Monday, November 3, 1997
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2 pm. Second Session with Jesse Trent. Although Jesse is trying hard to be loving and supportive to his wife after the rape, he is beginning to express a little of his own anger. Jesse is angry at the rapist, of course, but he has directed that anger appropriately at the perpetrator who is still at large. But the anger that is most destructive of his relationship with Maddie is that caused by her refusal to allow Jesse to get close to her and to try to help her deal with the emotional ramifications of the assault. She has distanced herself from him, using as an excuse her accusation that he shouldn't have gone back to St. Louis leaving her alone in the apartment at the time she was assaulted. It is very difficult to be emotionally supportive and defensive at the same time. Mostly, people are unable to nurture when there are unresolved issues of blame. Jesse recalls the emotionally healthy way that they supported each other after the car accident which resulted in Maddie's miscarriage, and he wants to be there for Maddie now in the same way. But she rebuffs his overtures with some pretty strong invective clearly designed to wound Jesse--attacks that he hasn't done anything with his life and even that he looked effeminate and foolish riding the scooter which she had given to him as a gift. While there are some supports for the victims of an assault such as Maddie suffered, there is little for the many other victims left by this type of attack. While Maddie undergoes therapy and rape crisis counseling, and while she fills her nights with self defense classes geared to women, Jesse is afraid to reveal to Maddie that he is in therapy, because he doesn't want her to perceive him as selfish. Meanwhile, both Jesse's and Maddie's families are really impossible. Jesse's family apparently went so far as to suggest that Maddie's attire--which Jesse describes as baggy t-shirts and jeans--somehow prompted the assault in her own apartment! And Maddie's family places the blame squarely at Jesse's feet both for not being there that night and for prompting the move to San Francisco, which they view as crime-infested and morally reprehensible. As emotionally distant as Maddie feels to Jesse right now, there are signs that Maddie realizes that Jesse is truly not to blame--she refused to consider her parent's suggestion that she leave Jesse and move back with them. I believe that Maddie just needs a focus of blame so that the assault doesn't seem wholly uncontrollable. If Jesse is to blame, then some control can be reasserted. Moreover, Maddie needs to turn inward to shield her vulnerability. Although I'm not a big fan of repression, I think that sometimes it is not productive to display large emotional wounds too early outside of a controlled clinical setting. Perhaps Maddie senses that she needs to internalize her feelings first before she can open up with Jesse. I hope that Maddie's therapist is interested in consolidating the support structures which Maddie has available to her, rather than utilizing this opportunity to advance a feminist political agenda--exploring all of Maddie's feelings about relationships with men in general, and Jesse in particular.
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Tuesday, November 4, 1997
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3 pm. Fourth Session with Rachel Tanner. Rachel's fidgeting might have decreased, but her hair thinning continues and she now looks as if she has been plucking her eyebrows. But overall, we may have made some small headway in the counting rituals. She played the tape we made last session 20 times in the first three days and was able to replace one ritual for another--but only after checking with Michael and making sure that he hadn't been harmed by the substitution. Rachel's grandmother heard the tape and it precipitated a frank discussion about Rachel's problems. Rachel's grandmother revealed, in some detail, the OCD difficulties that Rachel's mother had--including particular phobias against contamination. I think that Rachel believes that we are making progress in the sessions, and I tried to reinforce that belief by summarizing the positive results we've already achieved. Rachel is willing to try a somatic treatment, so I prescribed 20 mg. of Fluoxetine, once each morning, as the beginning of an eight week trial, and I warned her of possible side effects.
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Wednesday, November 5, 1997
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4 pm. Twenty-Fourth Session with Katherine Lippard. We spent the session exploring Katherine's feelings towards her mother. Katherine is still angry about her mother's actions which resulted in Katherine being convinced that her father had abandoned her. He did chose to leave the family rather than to postpone his desire until the children were older. But Katherine's mother didn't want to raise her family in the wilds of Alaska, and didn't want her children making the decision to visit him there periodically. So Katherine's mother asked him not to call anymore--resulting in Katherine's lifelong belief that he had abandoned her because of some failing within herself. While Katherine now understands her mother's reasons for making these decisions--for example, Katherine and her brothers wouldn't have gotten the education that they did if they chose to be with their father--she is still very angry at her. Katherine described the dynamics of her relationship with her mother. She said that her mother was a "despot" who would quickly punish when she felt she'd been crossed. While Katherine was spanked on occasion, the punishment that she feared most was psychological--making Katherine feel guilty or worthless for her mistakes. Katherine's mother preached for repression as a cure for all emotional pain. Katherine is still afraid of allowing her emotions to run away with her. But she isn't afraid now of allowing herself to feel them--at some level. She talked to me about the five classic stages of grief--denial, anger, bargaining, depression, and acceptance--and tried to fit her feelings over her father's abandonment into them. But she said that she wasn't angry at her father, and was surprised when I asked her why. But that was at the end of the session, so it's a thread we'll pick up next time.
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Thursday, November 6, 1997
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10 am. Ninth Session with Decker Jenkins. Decker was in a very weird mood throughout the entire session. He kept saying that he felt normal--stressed it really. He has moved into a new place. One of his neighbors dropped by, and he smoked a joint with Decker. Decker sees it as part of his new freedom--an opportunity to experiment with all the things that were forbidden by Karen. I am very concerned, however, about Decker becoming involved with these types of substances. I think that the abuse of recreational drugs by psychotics is an extremely bad idea. Decker seemed to come all unglued when I chided him on this, and ended the session early.
4 pm. Sixty-First Session with Anna Green. I pushed Anna on the different feelings that Anna, Martin, and Kathy each have for the other. Anna responded by telling me about the color red. See, there's purple-red and there's orange-red, but they're both red. Anna didn't explain whether she felt purple-red or orange-red for Kathy or which red she felt for Martin, but it was pretty clear by the end of the session that Kathy is just a plaything for Martin and Anna to share together before they move their relationship to a more serious plane. I tried to point out the hypocrisy of that attitude, but Anna insisted on not seeing the long view. She put off her concern all to being premenstrual and inappropriately jealous when she "caught" Martin and Kathy making love alone with each other without her specific consent last week. Anna is not getting the key issue that Kathy is going to be dumped on in this relationship, and it's going to be emotionally ugly for all concerned. And Anna neatly bypassed the touchy issue of her reluctance to perform homosexual acts with Kathy.
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Friday, November 7, 1997
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12 pm. First Session with Sharon Lough. Sharon is a 29 year old female of mixed racial heritage--she wrote on her form that her mother was Japanese and her father was Caucasian. She has a dark complexion and strong, handsome features. Her hair is brown in color and long and curly--she hides a bit behind her bangs. She avoided eye contact through much of the session, and spent a great deal of time nervously picking at her cuticles or her face or her hair. Her clothes were baggy, as if to hide the shape of her body, although she is physically quite attractive. Sharon has a slight stutter. When she is not picking at herself, Sharon makes a series of nervous hand gestures or she physically sits on her hands. Sharon is a current suicide risk. About a year ago, Sharon reports that she was abusing methamphetamines and became irrational, trying to provoke her boyfriend by breaking up his things. He responded with physical abuse, beating her up. They broke up, and about a month later she says that she was still angry with everyone, including her then boss who was blameless. She got into an argument with him and was fired. That triggered a suicide attempt which Sharon describes as half-hearted but which I believe was a serious effort to kill herself--the scars on her wrist run parallel to her forearm. She took a handful of pills, drank as much alcohol as she could, and cut her wrists. I think she's very lucky to be alive. Her experience at the hospital and at the inpatient mental health facility where she ended up was less than ideal, and she has a rather low opinion of psychiatrists in general, although she was quite cordial to me. But now Sharon feels the same pressures building on her that eventually led to her suicide attempt last time, and so she sought out my care. Physically, Sharon presents symptoms of stomach disorder (she thinks it may be an ulcer); migraine headaches; and back, shoulder and neck pain. Sharon is a secretary for an engineering group at SII, where she describes being hideously overworked. She also complains about her landlord and his family, who live in the apartment above her, and she complains about a co-worker whose slovenly habits and poor work ethic increase Sharon's workload. Sharon lives alone except for the company of a female ferret named Harriet. Ferret ownership is apparently illegal in California, and Sharon is a member of a group which is fighting to change the law, which Sharon described as stupid. In summary, Sharon is a suicide risk and has a history of both substance abuse and utilizing prescription drugs in an attempt to overdose. Obviously, I am going to be very leery of treating her with drugs. I'd like to spend the next session trying to get a handle on some of the emotional issues which led to her feeling of being overwhelmed. I think I'll split the time between trying to understand her current issues and trying to understand what precipitated her previous suicide attempt.
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Charles Balis' Personal Diary & Log