Doctor's Notes on Eliza Raven

Tuesday, February 11, 1997	12 pm. First Session with Eliza Raven. I got a message from a rather gruff and apparently hostile unidentified male making an appointment for Ms. Raven at noon today. All I knew about her was that she worked in the direct marketing department at SII. Elizabeth Josephine Ravenski, 20, appeared on time and came and perched rather nervously on the edge of my chair. She calls herself Eliza Raven. The gruff male voice on my answering machine was her fiancé Luke. Apparently she is phobic about initiating contact with strangers over the telephone. Luke, while not very sympathetic to her discomfiture, does much of her calling for her. I have to say that from Luke's somewhat hostile tone on my message machine, I can't imagine he is an extremely competent social secretary. But Eliza credits Luke with getting her into therapy, although perhaps she is giving him that credit because he made the phone call at her request. Eliza is a short and stocky woman, with a pleasing appearance. For this session, she dressed conservatively and monochromatically in a gray skirt and a long black sweater. Her hair is black and her complexion is quite fair. What was particularly striking was her eyes--they were this intense violet color which is quite unnatural. She was obviously wearing colored contact lenses. I had the sensation that she was able to hide behind her contacts just as many can hide behind their glasses. She was agitated during our session, nervously fidgeting with an embroidered handkerchief which would appear and disappear from this giant stuffed black purse which she clutched. She nervously twirls her hair around her forefinger, sometimes sucking on the end of a curl. She persistently crossed and recrossed her legs and kept trying to pull lower the extremely modest hem of her knee-length skirt. As she reeked of cigarette smoke, and her fingers were slightly yellowed, I assume that she is a smoker. Being a smoker in San Francisco places you in a category tolerated only slightly better than lepers. Every day I see pathetic knots of smokers huddled in the doorway of each office building in town, commiserating with each other over the change in laws which suddenly evicted them from their offices while they indulge their habit. Perhaps her nervousness during our sessions could be attributed to her inability to light up. Beyond being phobic about using the telephone, Eliza herself has not given any particular reason why she is seeking my help. The content of the session itself mostly involved traumatic memories of her mother while Eliza was between seven and nine. Deteriorating relations between Eliza's parents led to some domestic violence and culminated in her Mother's sudden disappearance. Eliza described going through a symbolic burial of her mother when Eliza was about nine. She describes the period after her mother left as a happy one for her--she became closer to her father and, together with her older brother Isaac, took on some of her mother's responsibilities. Eliza clearly idolizes both her father and her fiancé Luke. Her father was a musician and actor who gave it up to raise his family. However, Eliza described her maternal grandparents as both very wealthy and supportive of Eliza's parents marriage. Apparently, not enough of that wealth trickled into the marriage to stop Eliza's father from dashing his dreams and taking on more pedestrian work. Several times during the session, Eliza broke into tears. Mostly these tears were triggered by the memory of a particularly egregious childhood injury. Eliza recounted the occasion when her mother forgot Eliza's seventh birthday. Her mother came home late and was confronted by her husband. They had a loud and angry fight which brought young Eliza out of her bed to investigate. Her mother responded to Eliza's entrance into their bedroom by taking Eliza back and spanking her. The injustice of this act resounds in Eliza's tone of voice even today. Actually, sometimes Eliza has almost an old fashioned cadence to her speech--a rhythm from another century. When she said goodbye, for example, she said, "Farewell good Doctor Balis." I refrained from saying in return, "Ta Ta."
Wednesday, February 12, 1997	5:15 pm. Telephone Conversation with Luke Howard regarding Eliza Raven. I had a brief but unpleasant conversation with Mr. Howard, Ms. Raven's fiancé. Mr. Howard was upset because Eliza apparently had a "crying fit" after our session yesterday. He did say that crying fits were the reason that Eliza is seeking my help. He threatened me with a good talking to by his lawyer if I don't keep my sessions to an approved list of topics. I would have told him to go to hell, but he hung up too fast.
Thursday, February 13, 1997	9 am. A Letter from Eliza was slipped under my door this morning. She apologizes for Luke's telephone call yesterday and excoriates him for his conduct. But beneath the words, I get a sense that she's proud of him for standing up for her. She said a few interesting things in the letter--one, when threatening to use the absence of sex to punish Luke, she admits that she has a stronger sexual drive than he does and feels that it is really punishing herself. She also says that she is on medication of some type, although I wasn't aware of her taking any medications. She writes little haikus and limericks at the bottom of the letter. She also writes about talking to herself rather than to others as a way to calm herself and solve problems.
Tuesday, February 18, 1997	12 pm. Second Session with Eliza Raven. This was a very revealing session. I'm starting to feel like I'm getting some sense of Eliza and her problems. Apparently Eliza is involved with a band. About two years ago, she was driving back from a performance with Gary, her fiancé's father. Gary was a bit drunk and he was driving. There was a head-on collision which caused Gary's death. Eliza was thrown from the car and had multiple injuries, including cranial trauma. She was in a coma for a week after the accident. After regaining consciousness, she learned that she had been pregnant and had suffered a trauma-induced miscarriage. Luke didn't help matters much--when she told him that she had been pregnant and had suffered a miscarriage, Luke blamed her for the accident using some theory that I can't fathom. She is having a horrific recurring nightmare about the accident which quite specifically internalizes the guilt which Luke wishes to lay at her feet. The dream has her acting in a malicious, evil manner to intentionally cause the accident, escaping serious injury herself. She tears the little baby apart and then is horrified when, zombie-like, Gary and the baby come after her and tear the skin from her face and arms. We clearly have a lot of work to do. Eliza is used to other people making decisions for her, although she doesn't like it much. In the safe confines of my office, she rails against the restrictions, but clearly she takes it somewhat passively when the power of decision is taken from her. Since the accident, she has undergone extensive medical treatment. Physically, she seems in good shape. Although she said that she had facial reconstructive surgery, I really didn't notice anything until I looked quite closely. Under close examination, there are hairline scars following the line under her chin, but it really is remarkable work. She wears long sleeves, but I caught a glimpse of one of her arms and it has clearly been massively abraded. She has been in a large amount of pain since the accident, and is taking Percocets. She has also started to have crying spells with a frequency from once a week to twice a day. The crying spells seem uncontrollable and are accompanied by nosebleeds. During the session, Eliza constantly fiddled with a handkerchief--twisting it and trying to tear at its corners. At one point, she accidentally spilled a part of the contents of that giant stuffed purse she carries. She had a whole carton of cigarettes inside, along with a package of three lighters in plastic, a notebook, several blood-stained handkerchiefs, a spare piece of clothing--it might have been a blouse, a bunch of candy wrappers, an old fashioned quill pen and a bottle of India ink, and a bunch of candy wrappers. She seems to prefer Skittles and Starburst candies. And that was not all the contents of the purse by any means. Eliza clearly gains security by being supplied with all her essentials all the time.
Tuesday, February 25, 1997	12 pm. Third Session with Eliza Raven. Luke joined Eliza during the first half of this session, against her will as it turned out. Luke is a presentable young man who is highly emotional and quite self righteous. He came across as somewhat of a bully--he thinks nothing of emotionally browbeating Eliza to get what he wants. She says that he only is verbally abusive, and then only when he is angry. But he is highly excitable and I imagine he is angry quite a bit. Eliza became increasingly hysterical during Luke's tirade, ending in uncontrollable crying and a substantial nosebleed. We probably stopped for a full 10 minutes during the session to allow her to regain control of herself. But Eliza didn't roll over for Luke during the session. Although I suspect that she is generally submissive to his wants, she was quite forthright in requesting that he leave and forcefully resisted his request to give up her preference in religious faith to his. Eliza is a devotee of Wicca, a religion which she describes as a descendant from ancient pagan religions which worship nature. Luke says that her religious practices are freaking out his mother, with whom they both live. I assume that both he and his mother are Catholic. At the end of the session, Eliza said that she had to go home to patch things up with Luke. It is her role to be the peacemaker, even though, from my vantage point, it would be more appropriate for Luke to apologize to Eliza. During the next session, I should explore the possibility of somatic treatments for Eliza. Perhaps a tranquilizer would be most appropriate, although I'm not convinced that she isn't suffering from depression.
Tuesday, March 4, 1997	12 pm. Fourth Session with Eliza Raven. Eliza made peace with Luke last week by agreeing to accompany him once to his church. She says that it was disastrous. She was pointed out publically as a "confirmed Satanist" and was the target of efforts to convert her. Even Luke realizes that it did not go well and he's been apologizing ever since. Eliza's father got engaged to Calypso, a black woman who Eliza believes is just what her father needs. Eliza thinks her mother is jealous of her ex-husband's fiancée and rebelled against her mother's interrogation over Calypso. Actually, Eliza's response seemed disproportionate to the stimulus. When I questioned her, Eliza admitted that she has a lot of unresolved anger towards her mother. We clearly have some work to do there. I started to explore the idea of a somatic treatment with Eliza. She is hesitant but willing. I told her that I would explore the pharmacology of an appropriate medication with her pain management specialist to make sure to avoid a drug interaction with all the pills that he's prescribing. I'm leaning towards a serotonin reuptake inhibitor--perhaps Zoloft.
Tuesday, March 18, 1997	12 pm. Fifth Session with Eliza Raven. Eliza looked a lot better this session, not nearly as drained, at least before it began. Luke begged his way to a forgiveness. Eliza also told me that she occasionally uses her lunch hour to take journeys on the astral plane. She sometimes writes down her experiences and she read me one which seemed important to her--about being a Raven (as in bird) and gently taunting a lone traveler in the form of a beautiful man. Although she didn't describe anything overtly sexual, Eliza clearly had a sexual interest in the male dream figure, even saying at one point that she didn't want Luke to catch her in the mini-affair she had on the astral plane. Eliza was annoyed with me when I suggested that she might have been dreaming rather than traveling in a spiritual world. She insisting that she knows the difference--this wasn't nighttime so she wasn't sleeping. This happened on her lunch hour while she was mediating, so it couldn't be a dream. I wasn't about to argue with her on this point. Eliza also reported that her crying spells are diminishing somewhat. She reports about a 50% reduction to once every other day or so. When I suggested that we try Zoloft, she told me that she is taking birth control pills and wanted me to check to make sure there was no drug interaction. She's taking Triphasil 28 and I don't see any relevant drug interaction. But Eliza smokes and my PDR warns that smoking while taking Triphasil 28 can increase the risk of serious cardiovascular side effects. It says that women who use oral contraceptives in general should be strongly advised not to smoke. I'm not sure that she will welcome this news from her psychiatrist, but I should point it out to her during our next session. We started to talk about the anger that Eliza feels towards her mother. The anger was so strong that Eliza said it's only recently that she can be in the same room with her mother without fantasizing about murdering her. Apparently, her father and brother never had that kind of anger towards Eliza's mother after her departure. Eliza describes their reaction as denial followed by mourning as if her mother was dead. Eliza believes that she has taken on her father's and brother's anger for them, relieving them of the burden of feeling it. And, in fact, Eliza feels a lot of anger towards her father and her brother too. I decided to explore that anger in a little more detail and became fairly aggressive in my questioning. I demanded that she try to justify the anger towards her brother and father. Of course, I'm not very interested in logical justifications for such things, but I felt that it would be an effective avenue to explore these feelings. And indeed it was. Eliza admitted that she idolized her mother prior to her leaving. She envied her the position she had at the center of the family, on a pedestal. When her mother left, Eliza took over that position. But she was too young and the burden was too much for a scared little girl, as she put it. She reacted to the loneliness and to the responsibilities of her position by repressing a lot of anger and resentment. When the image of her mother was unable to absorb any more of her anger, she directed it against her father and her brother. Without communicating with them and while actively hiding her feelings, she resented that her father and brother didn't divine her needs. And she was angry with them for putting her into the position that she had really wanted to be in originally. Eliza wept twice during the session, the second time accompanied by a nosebleed. And although she was angry with me for making her cry, she admitted that the session had been valuable.
Tuesday, April 8, 1997	12 pm. Sixth Session with Eliza Raven. Eliza apologized for missing our last few sessions and took it rather personally when I chided her on it. Her family is in the process of turning itself inside out, apparently. Her father is remarrying, and her brother and Eliza herself are both in wedding preparations. Apparently, her father is reacting to his approaching nuptials with some introspection, which is causing a certain emotional discord in the family. Eliza is even patching together a relationship with her mother. They are both in therapy and are using it as a common bond. I think Eliza is able to open up to her mother and see her as more human because she is discussing her mother's frailities rather than aggressively seeking answers as to why her mother behaved in a certain way. But while Eliza's relationship with her mother improves, her relationship with her father is more strained and distant. Possibly, her father's strong emotional ties to Eliza's mother aren't severed and his upcoming marriage to Calypso is causing him to contemplate their complete break. I didn't tell Eliza that. I merely suggested that she try to talk to her father and raise these issues. I prescribed Zoloft, 100 mg. once each morning. I'm proposing a 6-8 week trial to evaluate the medication's effect.
Tuesday, April 15, 1997	12 pm. Seventh Session with Eliza Raven. At the time of her appointment, Eliza rushed into my office sobbing and jumped onto my lap. Before I knew it, she had a nose-bleed all over my shirt. I felt like the Doctor from some slasher movie during most of the session--I tried to ignore the fact that I was covered in gore. And I thought that as a therapist I had escaped the risks that my surgeon and dentist friends face with AIDs. Anyway, I finally got her calmed down and into a chair. She was very apologetic and explained that Luke had recently broken up with her. Apparently, Luke had been trying to understand Eliza's experimentation with the astral plane. Eliza told Luke about her sexual fantasy made manifest that she previously told me about--a sexual encounter with a stranger on the astral plane. Luke didn't take it well. He equated her fantasy adventure with a real experience, said that she was cheating on him, called her a nymphomaniac-- apparently he has a lower sex drive than she does--packed her bags and threw her out. Now, Eliza is staying with her mother and stepfather. She said that her mom was being quite supportive of her and even called in sick for her at work. A side benefit of staying with her mom is that Eliza is getting to know her stepfather, who she had always dismissed before as a conservative, but whom she now sees has another nice, quietly domestic side. Her father had a crisis in his relationship with Calypso--he broke off their engagement and asked everyone to leave him alone. Now they have reconciled, but he is starting in therapy to work out some issues, as he put it. Apparently, Eliza's father still has strong unresolved feelings for Eliza's mother, which surfaced when he considered a commitment to Calypso. Before Eliza left today, she gave me a ticket and a backstage pass to her band's concert. I think she sings for a group called the "Dozin' Pozers." The ticket is on the 25th of April, and I'd like to go--it would be good to see Eliza outside of the confines of this office.
Tuesday, April 22, 1997	12 pm. Eighth Session with Eliza Raven. We skipped around from subject to subject during this session, but I didn't feel that we were getting to the core of Eliza's difficulties. I have noticed a change since prescribing the Zoloft, particularly in the reduction of crying episodes that plagued Eliza during our first sessions--although last week's shirt was a total loss. This session was mostly about her relationship with her family, including her prospective husband, Luke who groveled his way back into her good graces. She was sporting a rather large diamond ring during this session which she waved proudly at me, calling it "Luke's apology." She seemed fairly happy about being back together with him though. She's gained more self-confidence lately. She was able to stand up both to a collection agency, and to her mother, all in one week. She finally convinced her mother that she didn't like pink by saying that her mom was Spring and she was Winter, or some such. And, more importantly, she told her mother that she was unwilling to allow her to usurp her father's position in her heart as the dominant nurturer during her adolescence--her mother, if you will. While not apologizing for leaving, her mother acknowledged that her father had raised her, and wept over what a good job he had done. Eliza found herself taking on the mothering role with her own mother, which she described as strange but not painful. Eliza also talked about her father and his therapist. The therapist, who doesn't garner a lot of Eliza's respect, told her father to rid himself of all tangible reminders of Eliza's mother. Apparently, her father is still torn by grief for the loss he feels from the breakup with Eliza's mother, many years before. Eliza proudly described how her father stood up to Ben, her mother's new husband, as her father delivered the remnants of his marriage to the front door of his ex-wife's new house. His therapist apparently recommended that he cut all images of his ex-wife out of family photographs. I agree with Eliza that such an action would have been extreme. Her father was unable to comply. Eliza told me about her band, which sounds like quite a collection of characters. She described a gay couple like a Thurber cartoon, with one of the partners acting like the little man in those cartoons, while a man named Anders plays the role of the huge female. Anders is a drag queen who is part of the group. Most surprisingly, I think she referred to the same Malcolm that Christina Herald is seeing currently. I don't think that there's any connection between Eliza and Christina, although it is possible that they are somehow connected through Christina's father at SII. But she described a very tall, dark, gloomy, dangerous character with the nickname Malcolm the Malcontent. How many can there be? Apparently, Eliza's Malcolm is responsible for impregnating Eliza's best friend Camille, although Malcolm is unaware of that turn of events. Camille, whom Eliza described as both extremely wild and promiscuous, has invited Malcolm to the concert on Friday to tell him of her pregnancy and to try to win him back. It promises to be a tumultuous evening, regardless of the quality of the music.
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.
Thursday, May 1, 1997	12 pm. Eighth Session with Christina Herald related to Eliza Raven. 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. 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.
Monday, May 5, 1997	5 pm. Telephone Conversation with Luke Howard respecting Eliza Raven. Luke called looking for Eliza. Apparently, Eliza moved out of his mother's house, taking all her possessions but leaving him his ring along with the incriminating photographs and a video, the contents of which are still mysterious. Luke has filed a missing person's report with the police, and when I refused to give him any information, he proceeded to personally threaten me in the most violent of terms.
Tuesday, May 6, 1997	12 pm. Tenth Session with Eliza Raven. Eliza is living as a prisoner inside the palatial walls of her mother's plantation. I had no idea that there was so much wealth in her family. I had pictured small, clapboard houses--instead, what greeted me was a huge old mansion with tall pine trees lining a cobblestone drive. Eliza is living in fear of Luke, and after her description of him as sometimes following through with his threats, I'm not completely calm about the things he said he'd do to me either. He seems to be stalking Eliza, although she's having a hard time admitting it. But he's threatened to kill her, he's followed her in his car, he's parked his car across the street overnight. At one point, she even said that she still cares about him and that she had to stop herself from calling him to apologize for leaving. Eliza said that she's experiencing something akin to grief over the loss of Luke. I thought Eliza should seek a restraining order. Actually, I might seek one. I certainly will if I see a red Ferrari hanging around me. Eliza has also been afraid to call Peter. I thought at first that she was afraid for Peter's sake--that she didn't want to get him involved in Luke's rages. As we explored the subject, though, at first Eliza indicated that she was afraid of Serena answering Peter's phone. And then Eliza told me something that I hadn't learned in the previous nine sessions--she has problems calling people on the phone in general. Her mind keeps asking "what if" questions, until she can't go through with her intention to call. Interesting. Eliza gave me her journal which I haven't yet had a chance to read.
Tuesday, May 13, 1997	12 pm. Eleventh Session with Eliza Raven. "Luke the Puke," as Eliza picturesquely named him in her journal last week, sent Eliza the most god-awful Mother's Day "present"--a vicious reminder of the miscarriage she suffered two years ago when Gary, Luke's drunken father, lost control of the car and killed himself and injured Eliza, causing her to lose the baby. Luke sent Eliza a doll with a severed head which fell off when she picked it up. Eliza has never come to emotional terms with the loss that she suffered. She has repressed her feelings about the loss of her baby, but those feelings started welling up on Mother's Day even before she received Luke's malicious gift. Eliza feels that there was no closure to the loss of her daughter--the doctor told her that she was pregnant and had suffered a miscarriage and that was that. While Gary had a funeral and his family was given the opportunity to grieve, Eliza was never given a chance herself to come to terms with her loss. When someone suffers a miscarriage, others tend to deal with it as an illness that the person is going through. There is little thought given to the life of the child that was lost. But to Eliza, even though she didn't know of its existence until after her miscarriage, the little girl she lost was more than a potential child. She was real. Eliza grieves now for the two year old child that she would be now. I suggested that she acknowledge her loss in some spiritual fashion, which seemed to strike a chord in Eliza. Peter figures strongly in Eliza's hopes for the future--it was even more apparent in the journal that she handed to me at the end of this session. Peter told Eliza that I was his therapist, and Eliza was a bit hurt that I hadn't told her that. But I assured her that the confidentiality between sessions was a two way street, and that her confidences were as safe with me as Peter's had been. Luke's physical abuse of Eliza was more severe than I had imagined. I wouldn't be surprised to discover that many of the injuries that Eliza claimed to have received in the car accident were actually caused by Luke, who blamed Eliza for his father's death. Eliza admitted that she had been thrown down a staircase by Luke, causing her to break her wrist, her ankle, and bruise her ribs. Personally, I think Luke should be jailed, and I definitely think Eliza should get a restraining order. He is a dangerous man and this might not end well.
Tuesday, May 20, 1997	12 pm. Twelfth Session with Eliza Raven. Eliza is suffering from some random pains all over her body, seemingly with no obvious causation. When she came into the office, she was almost crippled with pain--she was very pale and almost passed out. When I couple her symptoms together with what I know from Peter about Serena's black magic, I think it possible that Eliza is suffering from the results of Serena's voodoo. Although Eliza denies that she believes it, patients such as Eliza who believe in magic and supernatural phenomenon in general are prime candidates for self delusion. They can exhibit real suffering from the effects of, for example, a voodoo curse. Eliza believes that Serena is cursing her, so she is feeling the effects. Just because it is in Eliza's mind doesn't mean that it isn't real for her and has to be treated. Eliza is already taking percocets for the pain related to her car accident. I think she's using the same medication to treat some of her newly experienced symptoms as well. Percocet is a narcotic and it makes her even that much more susceptible to Serena's suggestion. I'm afraid that I'll have to find some way which Eliza believes to be effective to protect her from Serena's black magic. Also, Eliza is being hunted by Luke. She refuses to get a protective order against him, and she resents my pushing on the subject. In fact, she resists so strongly that I suspect that she has some other motivation for avoiding the restraining order. She talked about the extent of the abuse that she suffered in Luke's hands, and although she says that none of the car accident injuries were actually Luke's doing, she does relate a series of horrendous accounts of abuse. Eliza told me a story about her adventures on the astral plane and how she has two guardians--Letitia and Mordred. In her latest adventure, Eliza was able to save her guardians from harm. In return, they promised to spend their lives trying to repay her. Perhaps that is a key to neutralizing the effects of Serena.
Friday, May 23, 1997	I sent an e-mail response to Peter Hossfeld which related to Eliza Raven. Mostly more of the same, with my trying to distance Peter from his magical constructs, although I was particularly concerned about Serena's attempt to use voodoo on Eliza. I told Peter that I believed that he had communicated something about Serena's attempt to Eliza and that Eliza's recent pains might be attributed to her belief that Serena is trying to cause her harm. Unfortunately, they are both magical thinkers and Eliza's problems will probably have to be confronted by using some form of magical remedy. If she was a devout catholic, I'd say use an exorcism. But as a wiccan priestest, we'll have to find some other appropriate magical methods. Perhaps Peter can help Eliza on that level rather than by confronted Serena directly, which he seems loathe to do. I can hope that Peter will try to play the night in shining armour for Eliza and the prospect of Serena causing her harm will actually give him some backbone and inspire him to stand up to her.
Monday, May 26, 1997	10:30 pm. I visited Eliza in the hospital. I got a call from a Slavic sounding man who identified himself as Eliza's father and told me that she was in the hospital asking for me. I hurried down to the CPMC Cherry Street campus, and found Eliza in the cardiac ward. Apparently, she had been complaining of sharp, undifferentiated pains in various parts of her body and someone thought she might be having a heart attack when she was admitted. She wasn't. This evening, she was having a party at her mother's mansion mostly for the purpose of allowing her to introduce her new friend, Christina Herald, to Peter Hossfeld. Well, seeing Peter at the house must have been too much for Luke, who burst in and started to bodily threaten Eliza. Peter intervened and got Luke away from Eliza, and Luke assaulted Peter. Malcolm happened to arrive in what must have been either an extremely provident coincidence, or Christina is dating Malcolm again. Anyway, his martial arts skills came in handy to immobilize Luke until the police arrived. So Eliza has her restraining order, after all. Eliza wasn't hospitalized as a result of the assault by Luke, although her pains might have been triggered by the assault. I talked to the attending physician, a Dr. Culter whom I didn't know. He said that Eliza's pains were probably a reaction to the shock she experienced. He planned to hold her overnight and then release her in the morning. I had a chance to meet Eliza's mother--Ms. Rebecca Jacobsen. She was extremely attractive, almost Egyptian looking, with wide-set emerald green eyes and black curly hair. You could hardly credit her with having a daughter of Eliza's age. She had an almost regal presence that was palpable. Very impressive. Eliza said that she had just gone to the movies, but she was wearing a very expensive tailored suit in pearl gray, with not a hair out of place. If she dresses like that to go to a movie, she must be always impeccably tailored. Not at all the image that I had of her from the content of our sessions.
Tuesday, May 27, 1997	12 pm. Thirteenth Session with Eliza Raven. Eliza was released from the hospital and came to our session at her usual time. She admitted that she had tricked me into disclosing that Christina Herald was my patient--annoying, but I saw no reason to make a big deal about it. Christina strikes me as the type of woman who would have freely told Eliza the name of her therapist. The revelation which is most sensitive to most patients is the fact of undergoing therapy at all, which Christina freely discussed in her conversations with Eliza. At any rate, Eliza threatened to conspire with her new friend Christina to fix me up on a date. My experiences with blind dates have left me less than ecstatic over the prospect. Eliza described in a bit more detail the events at her Memorial Day soirée yesterday. It turns out that Malcolm was there through a romantic effort by Anders to reunite Christina with Malcolm. Eliza doesn't think it likely that Christina will take Malcolm back--both Christina and Eliza feel angry that they were lied to by Malcolm, although Eliza feels grateful that Malcolm saved Peter yesterday. Eliza talked about the possibility that she was the victim of Serena's voodoo. While Eliza discounted the possibility, she also said that the Wiccan Law of Three would ravage Serena if she was, in fact, using her magic to harm Eliza. Essentially, the Law of Three says that the doer of bad deeds receives the same harm back, but magnified thrice. It seems that Eliza is also marshaling her allies on the astral plane to rally to her assistance and is taking steps to strengthen her aura. I'm not sure what all this means in mystical terms, but Eliza is clearly fortifying herself for the battle she apparently must wage with Serena for Peter's soul. Eliza talked about her paternal grandparents who are both involved in Wiccan religions. They've moved to a farm up north and, according to Eliza, they live an idyllic pagan lifestyle. They were Eliza initiators to Wicca and she is very grateful to them for setting her spiritual direction. On Mother's Day, Luke had given Eliza a broken doll out of a malicious desire to remind Eliza of her own miscarriage. But some good seems to have come out of the hateful act. Over the weekend, Eliza and her grandparents buried the doll and Eliza used the opportunity to have a funeral for the lost baby, which she says brought her a sense of peace. Eliza said that they set the baby free by laying her memory to rest. Eliza told me more about the relationship between Anders and Phillip, and the sexual preference confusion of Josie, who believes that he is not gay because of something a psychic told him. Furthermore, Isaac--Eliza's brother--broke up with his girlfriend. So Eliza feels like she is being smothered in the emotional problems of others. She became quite emotional over the prospect of being alone--she thinks of herself that way, even despite her blossoming romance with Peter. Eliza believes that Zoloft has helped her quite a bit. She feels more in control of her emotions and her life. I also agree that Zoloft seems to have had a positive effect on Eliza's personality, making her more outwardly directed rather than inwardly brooding. Eliza cried during this session, but unlike previous emotional displays, Eliza seemed more in control and she didn't suffer any nosebleeds.
Thursday, May 29, 1997	12 pm. Eleventh Session with Christina Herald relating to Eliza Raven. Christina came in sporting an impressive black eye. Although I already knew the story from Eliza, I had to pretend that I did not. Luke hit Christina while she was at Eliza's house to meet Peter. Luke burst in and assaulted the people there--especially Peter, whose injuries I haven't heard about yet.
Monday, June 9, 1997	Peter Hossfeld e-mail partly related to Eliza Raven. Serena makes Peter important in a way that he could never be by himself. But Eliza gives Peter a reason to trade-in what Serena offers for something a bit more emotionally satisfying and tangible. Peter described the scene at Eliza's house where Luke assaulted Eliza and him. He saw Malcolm not as a person but as a karmic force--overwhelming Luke with a blur of motion. He said that he never saw anybody hit in so many places so fast. Malcolm must really be good. Peter, in contrast, thinks of himself as a spineless wimp. My guess is that he is really in love with Eliza. She is definitely the key to bringing Peter back from the brink.
Tuesday, June 17, 1997	12 pm. Fourteenth Session with Eliza Raven. Eliza came in with bandages around her slashed wrists and the heels of her hands. She apparently tried to commit suicide by hacking at her wrists with an x-acto knife. I had no idea that Eliza was a suicide risk, and I was quite shocked. I knew she was depressed, of course, but I didn't recognize the depth of her depression. It somewhat shakes my confidence. And this was a close call. Eliza said that the reason that she stopped herself was that she thought of Peter, crying at her grave site. It's awkward with both Eliza and Peter as my patients, but I think it might be appropriate for me to contact Peter and let him know that it would not be amiss for him to contact Eliza. But that will have to wait. I thought it was my clear obligation to hospitalize Eliza--I think she is at risk for another attempt. When she started the session, she told me that she was sorry that she hadn't succeeded on her first attempt. Eliza was found by her mother in the bathroom, bleeding profusely. Her mother didn't handle it well, although Ben--her stepfather--stopped the bleeding and tried to comfort her the best that he could. He was the one who took Eliza to her session today. I wish they realized that the situation was serious enough to contact me right away or take Eliza to the hospital immediately. Eliza admitted that she takes her medication rather sporadically--she estimates a couple of times a week. I met Ben outside and he acquiesced in my decision to hospitalize Eliza. He said that he would gather up a few personal effects that Eliza requested. I took Eliza myself to the Adult Inpatient Mental Health Facility at the California Pacific Medical Center, Pacific Campus. Eliza signed the voluntary commitment papers. I wrote up a set of orders including the proper administration of her medication (Zoloft, 100 mg.) and a suicide watch for the next 48 hours, after which I'll make an evaluation. I'll be stopping by daily as well to check on her.
Tuesday, June 24, 1997	12 pm. I visited Eliza in the hospital today. She was in good spirits and seems to be responding well to the medication and her circumstances. She's off the suicide watch and has joined the ward. She told me that her view of mental hospitals had been colored by "Amadeus" and "One Flew Over the Cuckoo's Nest." But other than complaining quite bitterly over the food, she says that she has been pleasantly surprised. I spoke with the psychiatric resident who is treating Eliza, and we agreed, even though she is doing quite well, to keep her there a bit longer.
Thursday, June 26, 1997	12 pm. Fourteenth Session with Christina Herald relating to Eliza Raven. Near the end of the session, Christina asked me about Eliza, although she was clearly uncomfortable doing so. And I was uncomfortable as well. I really couldn't tell Christina that Eliza was in a psychiatric facility, but Christina was obviously concerned about her physical well-being. I told Christina that Eliza hadn't been physically injured and that her parents would be able to get a letter or present to her. Christina grabbed at the suggestion and tactfully changed the subject.
Tuesday, July 1, 1997	Eliza is being released from the hospital today. I wanted to have a session right away to help her transition back into her normal life, so we've scheduled an appointment tomorrow morning. I've spoken with the resident and she seemed to be doing quite well with an upbeat attitude. Obviously, I'd like to judge that for myself--Eliza is quite accomplished and could easily snow a fresh-faced psychiatric resident into believing whatever she wanted him to believe. However, based upon my visits with her last week and this, I agree with the decision to release. However, most suicides occur during the recovery phase of a depression when the patient has enough energy to actually commit the act. Therefore, I will not hesitate to recommend readmission if I feel it necessary.
Wednesday, July 2, 1997	10 am. Fifteenth Session with Eliza Raven. I had my first session with Eliza since her release from the in-patient mental health facility at the California Pacific Medical Center. Eliza was edgy, and seemed forced--although she was trying to convince me that she was making a wonderful recovery and that it wasn't my fault that she tried to commit suicide. My guess is that she had two weeks of practice telling nurses, doctors, and friends and family that she's fine, really fine, "let me go now. No, I'm not planning on killing myself, but thank you for asking." Although I don't believe that she has any current plans to commit suicide, I also don't think she has come as far as she is trying to convince herself that she has. In addition, Eliza seemed ravaged by guilt. She constantly talked about disappointing everybody and letting everybody down. It was as if she believed it was more important how everyone else felt about it than her own feelings. When she was in the hospital, she apparently saw Peter there as well, which could explain why I haven't heard from him for so long. Eliza told me before that she stopped herself from committing suicide after imagining Peter weeping at her grave. Seeing him reinforced that sense of guilt and responsibility. I should stop by and see Peter in the hospital as soon as I can. I talked to the hospital and obtained permission to allow Eliza's grandparents to have a religious ceremony involving their coven. Thirteen people came and cast something that Eliza called the SpiderWeb, which Eliza felt was extremely beneficial. And Eliza met Letitia and Mordred in person. Previously, she had only communed with them on the astral plane which, with Eliza's and Peter's experiences there, I'm starting to think of as a sort of astral chat room. Eliza got an inspirational story from Mordred--who turns out to be a ten year old boy--about a man who always had a positive attitude because he thought of life as a series of choices, and he chose to have a good outlook each morning. When the man was shot by robbers, he chose to live--and communicated his intention to the ER surgeons. I do believe that patients who are critically injured or ill can sometimes choose to live or give up and choose to die. Eliza identified with the man and said that she's chosen to live. I certainly hope so. I gave Eliza the first couple of chapters from "Rapid Relief from Emotional Distress." If nothing else, it will give Eliza a road map to a possible recovery.
Tuesday, July 8, 1997	12 pm. Sixteenth Session with Eliza Raven. Eliza believes that she may be in love with Peter Hossfeld. They got together at Peter's house--which I imagine was a considerable act of bravery for him--when Serena wasn't there. Eliza was shocked at Peter's physical condition--she described him as skeletal--until she found out that Serena is possibly poisoning Peter by having him drink belladonna and datura. I have no idea what the effects of these poisonous plants would be if ingested, although I seem to recall that belladonna has hallucinogenic properties. Peter was suggestible under the best of circumstances. Serena may be tightening her grasp by fiddling with Peter's wits. If Peter would sign out a complaint, or if Eliza could prove that Serena was actually poisoning Peter against his will, then the police could get involved. Eliza said that she would research that avenue. But she is clearly prepared to go to war with Serena. The second part of our session was even more disturbing. Eliza described how she constantly thought about suicide prior to her attempt. In contrast to last week, where Eliza was trying to convince me that everything was fine, this session I got the feeling that Eliza's constant thoughts of suicide was closer to how she actually feels--and it was a scary place to be. She said that, but for the fear of physical pain, she would have tried to commit suicide many previous times. She's contemplated killing herself by asphyxiation, drowning, and by overdose. And she said that she feels like she oscillates between happiness and sadness. The thoughts of suicide she analogized to a cancer and said that she feels her soul dying as a result. She even worries about being consumed by the emotions and becoming sublimated, somehow, to this "emotional bogey-man." She was administered the Wakefield Questionnaire and scored high for depression. Eliza seems to be describing cyclic depressive illness, but I don't think that she's met the criteria for bipolar mood disorder. But I think Eliza is clearly suffering from a major depressive episode. I remember the mnemonic from medical school: "Distraction Is Watching Sweet Midriffs of Erotic Girls Cavort Slowly." The initials are Depressed mood, Interest, Weight, Sleep, Motor activity, Energy, Guilt, Concentration, Suicide. During my next session with Eliza, I'd like to carefully explore her depression with reference to these classic symptoms.
Tuesday, July 15, 1997	1 pm. Eighth Session with Peter Hossfeld relating to Eliza Raven. Peter gave me a call yesterday and asked for an appointment. He came in wearing a bandage around his right hand. He told me that he had invited Eliza to visit him at his apartment when Serena wasn't there--very much the way that Eliza told it to me. Eliza came there at his invitation and discovered Serena's penchant for growing poisonous plants and keeping them in jars in the kitchen. Eliza apparently found foxglove, henbane, and jimson weed growing in Serena's pleasant little garden. And she also identified the poisons in the kitchen that Serena has probably been making into tea for Peter's consumption. Eliza destroyed much of Serena's garden and dumped her "teas" into the garbage. When Serena came home, well after Eliza had left, she was none too pleased at what she found. Eliza had left some sort of a sign in the garden, made out of sticks and rocks, that caused Serena some considerable consternation. Serena hit herself in her supposedly pregnant belly and said, among other things, "She did it all!" Peter tried to soothe her, but she grabbed his right hand and bit into it hard, breaking the skin. When I saw his hand, it was clearly infected and probably septic. After biting his hand, Serena disappeared. Peter hasn't heard from her in about a week--she hasn't even returned to retrieve her belongings.
Tuesday, July 22, 1997	12 pm. Seventeenth Session with Eliza Raven. Eliza announced that she's changing jobs. She's quitting SII and going to work at a metaphysics bookstore. Eliza complained about an inability to concentrate and to focus. She also said that her family's solicitousness in taking care of her is making her feel somewhat helpless. In describing her own mental state, Eliza said that she feels sad all the time--a combination of feeling like she has let her family down coupled with an overwhelming sense of guilt together with depression, resentment, and rage. In addition, Eliza described that she's having difficulty sleeping. Apparently, she falls asleep without difficulty but wakes up in the middle of the night after a nightmare and has difficulty falling back asleep. Eliza became quite distressed near the end of the session and said that she felt like she was being punished for something and doesn't know what she has done to deserve it. But Eliza reported good compliance with my instructions respecting the Zoloft that I prescribed and I see a difference in her from our sessions of just a few weeks ago. I'm hopeful that with Eliza's changed job, she'll have turned the corner on her depression.
Monday, August 04, 1997	1 pm. Ninth Session with Peter Hossfeld respecting Eliza Raven. Complicating Peter's return to the here and now is that apparently Eliza and he had a fight. Peter said that he finally had an opportunity to see Eliza free of Serena's influence--they had a date. But Peter describes his personal reactions to the evening as completely detached--as if he was watching a robot body go through the motions with Eliza while he remained aloof. He even described the event in the third person. From what Peter told me, it sounded like Eliza was really hurt by Peter's reaction during their date--she left in tears. I wonder if this incident has something to do with why I haven't heard from Eliza in the last couple of weeks.
Tuesday, August 12, 1997	12 pm. Eighteenth Session with Eliza Raven. Eliza dropped in unannounced and fortunately I was able to see her without an appointment. She looked like hell. Her eyes were red and bloodshot, her hair was greasy and unkempt, her complexion was sallow, and her mouth was set in a permanent scowl. She also lost some weight since I last saw her. She curled up in a chair, with her knees tucked into her chest. She spoke alternately in a flat monotone or bitingly spiteful tones, but not very much like the personable young woman that Eliza has always been. When she began to cry, she could not stop and she must have spent a full ten minutes crying during the session. Two traumatic events happened to Eliza since I last saw her. The first is that her mother and Ben demanded that she move out of their house. They provided her with an apartment and a source of funds, packed her possessions, and bodily removed her from the premises. Her mother said that she couldn't abide Eliza's "negativity." Eliza's felt that her mother had abandoned her for the second time. In subsequent conversations, Eliza said that she can't feel any love emanating from her mother and that she's aware of an icy detachment. Reeling from being evicted in this manner, Eliza sought Peter's company. Peter already described to me how disastrous that "date" really was. Eliza said that, instead of comforting her following her mother's actions, Peter blamed her for ruining his aspirations of becoming a higher-being. When Eliza tried to make it up to him by showing him signs of her physical affection, Peter turned cold. Eliza began to cry. She jumped up and ran out of the house, and Peter, of course, never followed. Eliza believes that Peter hates her and that she ruined his life. Eliza said that she took all the sharp instruments that surrounded her, including her Xacto knives, razor blades and cutlery, and threw them away. Although she used suicidal imagery in her conversation, I came to the conclusion that she wasn't an imminent danger to herself, although I believe that she must be carefully monitored to make sure that she doesn't turn towards more active suicidal ideation. She asked me to call her once a day just to check on her, and I'll do so. I think it's a good idea, given her somewhat brittle emotional state.
Monday, August 25, 1997	3 pm. Tenth Session with Peter Hossfeld respecting Eliza Raven. Peter got back together with Eliza for one date punctuated with apologies and tentative emotional gropings towards one another. They've both been scarred by Peter's "Robot" persona and both of them are taking the renewal of their relationship in slow steps. Peter told me that he was taking aspirin simultaneously with the phenytoin and it's possible that the interaction caused the sense of dislocation which Peter experienced previously.
Monday, October 27, 1997	10 am. Telephone Conversation with Sgt. Tracy Keefe respecting Peter Hossfeld. They just let him go. I finally got hold of Keefe and he told me that they released Peter on Wednesday. Keefe even told Peter that I intended to have him committed. I'm not surprised now that Peter hasn't contacted me. I guess I have little to do but just wait. The authorities are clearly not interested in trying to ward off a crime that hasn't yet occurred--Peter had turned himself in voluntarily, and they never even got him looked at by a psychiatrist. I feel a responsibility to warn Eliza of Peter's current condition, and I'll do so. But if Peter has really turned towards violence, there's little I can do to stop him unless he contacts me.

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Eliza Raven's Patient File

Charles Balis' Notes by Patient