Transcript of 3rd Session between Charles Balis, M.D. and Mr. Sam Eldrich, Thursday, June 4, 1998 at 2:00 pm.

Dr. Balis: Hello, Sam. Please come in.
Mr. Eldrich: Well, it's official, Doc.
Dr. Balis: What is?
Mr. Eldrich: I'm officially a high school graduate.
Dr. Balis: Congratulations. For some reason, I thought you already had the ceremony.
Mr. Eldrich: Well, seniors didn't have classes for the last couple of weeks. It was something about having to get grades computed early so they'd know if we should get a real diploma or a fake at the graduation ceremony. Of course it's not like a U.S. high school diploma really means much worldwide anymore.
Dr. Balis: Are you planning to go to school overseas?
Mr. Eldrich: No. I guess I'm still spouting the propaganda they drummed into our heads when we started the IB program.
Dr. Balis: IB program?
Mr. Eldrich: Jeez, I'm starting to think that no one outside of high school educational system has ever heard of it. IB stands for International Baccalaureate. It's like an Advanced Placement program, except that you're required to take at least four classes in different subject areas a year instead of picking one or two classes in your academic specialties. Some of the courses also last two years. In the end, the exams that you take aren't just scored against performance nationwide. They're sent across the globe to be graded and compared with how students across the world scored.
Dr. Balis: Interesting. It sounds demanding.
Mr. Eldrich: Yeah. They say that it's supposed to prepare us better for college. With all the late nights and seeming lack of social life I've had because of it, it better do something fantastic for me. Anyway, even though I've graduated from high school, I'm really waiting to see if I got my IB diploma.
Dr. Balis: When will you find that out?
Mr. Eldrich: They said that we should get the results in the mail by mid-July.
Dr. Balis: Do you think you have a good chance of getting it?
Mr. Eldrich: Yeah, I'm pretty sure I do. I'd still like the confirmation in the mailbox, though, you know?
Dr. Balis: I understand. You mentioned late nights and a restricted social life; do you feel this program put you under a great deal of academic stress?
Mr. Eldrich: You'd better believe it. There were a couple of times when I just wanted to quit the program and get out from under all that pressure. And I think there was one time that helped contribute to my little snap two weeks ago.
Dr. Balis: What was that time?
Mr. Eldrich: Well, for English class, we were reading Eugene O'Neill's "The Iceman Cometh." It was depressing as hell. If any of your patients come in reading it, tell them to stop before they get to the end.
Dr. Balis: What was so bad about the ending?
Mr. Eldrich: Well, throughout the whole play, this guy, Parritt, had been saying how useless his life was. At the end of the play, he jumps off the building in which all the action of the play takes place and kills himself. But all the people inside--all of them know he's done it--just keep laughing and partying as if nothing's happened.
Dr. Balis: Hmm.
Mr. Eldrich: This confirmed what I'd been thinking about all along. If this guy--whom everyone in that building supposedly knew and loved--could kill himself and nobody even cared, why in the world would it matter if I were to kill myself? Maybe I'd be one of the lucky ones and be able to slip off unnoticed, unmourned, and unloved like that.
Dr. Balis: Sam...
Mr. Eldrich: I know, Doc, I know. It probably sounds crazy to anyone on the outside...on the outside of what I'm feeling and why I'm feeling it. Anyway, can I finish the story?
Dr. Balis: Yes, but we'll need to return to the subject of how you're feeling now.
Mr. Eldrich: All right. Anyway, we had to read this play a couple of times: once to discuss the plot, and then a couple more times to pick up on all the different literary devices. We also had to make a notebook that covered the play in depth and analyzed how O'Neill achieved the effects that he did. But as we analyzed the play, that one scene just kept coming back to me.
Dr. Balis: Hmm.
Mr. Eldrich: After a while, I couldn't even read the rest of the play. I just kept thumbing back to that scene, trying to convince myself that it showed how the world would react if I were to kill myself. Then I thought that jumping off a building brought too much risk of surviving with severe brain damage. I searched through my mind for ways to kill myself which wouldn't have a risk of brain damage. I finally figured out that slitting my wrists would probably work well. And even if it didn't work, I'd have the scars to remind myself that it didn't work.
Dr. Balis: Do you still have a plan like that?
Mr. Eldrich: Doc, it wasn't much of a plan to begin with. It was just a preferred method at that time; there was no elaboration on when or where I'd do it. As you could probably guess, I wasn't doing well on the notebook--I was too fixated on that scene. I figured that I should go in and talk to my teacher about either getting a serious extension on it or having some sort of replacement assignment so I wouldn't have to deal with that play or that scene anymore.
Dr. Balis: Did that work?
Mr. Eldrich: You know, Doc, I just realized that my whole obsession with this one detail of the play was like that guy in "The Telltale Heart," except that I didn't want to kill the play because of the detail. I wanted to kill myself and lie underneath the floorboards, dismembered.
Dr. Balis: Sam, do you feel that you pose a great threat to yourself right now?
Mr. Eldrich: Doc, that was how I was feeling about four months ago. I'm almost done with that, I promise. The play does turn out better than I'm making it sound right now, although now I've probably spoiled the ending for you.
Dr. Balis: That's okay.
Mr. Eldrich: To make it short, when she heard what it was doing to me, my English teacher told me that I didn't have to do the notebook at all. I can't tell you how much better I felt after that. She was the first person I was able to tell about how badly I was feeling at the time, and she didn't judge me to be a horrible person worthy of death as I saw myself. The real kicker was that I didn't even have to do a substitute assignment; I think she saw that dealing with having to go to class while that play was being studied was work enough for me.
Dr. Balis: I see. Now, Sam...
Mr. Eldrich: There's a little bit more which will lead right into how I'm feeling right now. I promise. When I was writing the IB exam for English about a month ago, I wanted to prove to myself that I was over that play. So I included an analysis of its structure in the essay. I figured that was innocuous enough to not require me to go into great depth about what happened in that final scene. I think the essay I wrote was pretty good, but it depends on whether the graders see it as a fresh take on an old cliché or just more pseudo-intellectual drivel.
Dr. Balis: How did it feel to write this essay?
Mr. Eldrich: Well, given that I snapped about two weeks after writing it, I'll let you be the judge.
Dr. Balis: Do you think it was the act of writing an essay about O'Niell's play that triggered your depression?
Mr. Eldrich: Bingo, Sherlock. I knew that all those degrees on the wall weren't from some mail-order company.
Dr. Balis: Sam, do you still feel that no one would care if you committed suicide?
Mr. Eldrich: To be honest, Doc, yes, I do. I don't see what there is to miss about me. I feel like I'm a person who has messed up his internal life so badly that I'm not even worth keeping alive any more. The only thing that keeps me from doing it right now is that I'm not exactly sure that God completely agrees with me yet.
Dr. Balis: Do you think God wants you to stay alive?
Mr. Eldrich: It's that whole jazz about being created in God's image. If nothing else, God took so much trouble to create my soul that I don't think he wants me to screw it up. But damn it, Doc, it's already screwed up! And no amount of talking about it is going to unscrew it. I've just got to learn that I'm completely fucked up and that there's absolutely nothing I can do to change it. I've got to learn to deal with it and move on.
Dr. Balis: Sam, you have to understand...
Mr. Eldrich: At least I've got to learn to keep other people happy. My own happiness has basically been declared D.O.A.
Dr. Balis: Sam, do you have any plans to kill yourself right now?
Mr. Eldrich: No, Doc. There's nothing concrete. I just have that thought about how knives won't cause brain damage.
Dr. Balis: Sam, you sound as if you're very close to committing suicide. I need for you to tell me exactly how close you are.
Mr. Eldrich: I'm not that close, really...well, not as close as I was two weeks ago. I think you're overreacting, Doc. You're just seeing my thoughts unedited, as it were. I edit them a lot myself before I go out and do anything.
Dr. Balis: Do you think that you are likely to follow through on these wishes to end your life?
Mr. Eldrich: Not anytime soon, anyway, Doc. I've got my thought editors--what I think God wants for me and what I think is my duty as a member of society--to take away the urgency from my desire to die. But I'm trying to change God's opinion on this and show him that I'm really right on this one--I should be left to die. If only God wasn't so damn stubborn...
Dr. Balis: Sam, I think that you might be helped by an antidepressant.
Mr. Eldrich: Great. Give me something to dope me up so my arguments against God lose their coherency.
Dr. Balis: It's not like that, Sam. Your suffering from depression. Depression is a disease, like the flu. What you're feeling right now is a result of that disease. The medication I'm going to precribe won't dope you up, but it will help you fight this disease. The antidepressant is not a cure in and of itself. It's just a tool to help you get better.
Mr. Eldrich: Why do I need to get better? I already see myself in a much clearer light than any of you on the outside do.
Dr. Balis: Your perceptions of yourself right now are highly skewed toward the negative. You've almost exclusively focused on the negative things in life, and you give no credence to the positive. You need to regain a balance and be able to assess yourself accurately.
Mr. Eldrich: If you say so.
Dr. Balis: Would you be willing to take an antidepressant?
Mr. Eldrich: Well, I guess. If what I'm feeling is true, a drug that's supposed to clear up my thinking should let me keep thinking the way I do right now, right?
Dr. Balis: All right. Do you know if anyone in your family has taken an antidepressant before?
Mr. Eldrich: Hmm...I think an uncle on my dad's side took Paxil to pretty good effect.
Dr. Balis: I think that Zoloft would be more appropriate for you than Paxil. So I'm going to write you a prescription. Do you think you would try to commit suicide by taking an overdose of drugs?
Mr. Eldrich: Good grief, no. It has the same problem as jumping off a building: you risk permanent brain damage.
Dr. Balis: Okay, I'll write you a prescription for a month's supply. It usually takes around four weeks for the drug to take effect, so please give it a chance to work. You take one pill each morning.
Mr. Eldrich: Fine. Whatever.
Dr. Balis: Sam, I'm still very concerned about you. Will you be all right until next week?
Mr. Eldrich: Yeah. If nothing else, I'll go out with some friends to take my mind off all this. Really, Doc, you've seen the worst of it today. I'm sorry to have bothered you with it and made you all concerned.
Dr. Balis: Sam, it's not a bother to me...
Mr. Eldrich: I know, Doc. It's just a pleasantry, I guess. Is there somewhere I can go fill this quickly?
Dr. Balis: There's a pharmacy downstairs. They'll fill this for you right away.
Mr. Eldrich: Okay. Thanks, Doc. I'll see you next week.
Dr. Balis: Take care, Sam. Please call me any time you feel an urge to...
Mr. Eldrich: Sure.
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