Transcript of 30th Session between Charles Balis, M.D. and Mr. Thomas Darden, Monday, August 17, 1998 at 12:00 pm.

Dr. Balis: Hello, Tom.
Mr. Darden: Hi.
Dr. Balis: Are you still feeling sick?
Mr. Darden: Do you mean since last we spoke? Dammit, I'm still not feeling well, not at all.
Dr. Balis: Have you seen a doctor about it?
Mr. Darden: Not besides yourself, no. But I've really felt out of it the past week or so. I guess I don't have much choice but to get checked out.
Dr. Balis: Can you describe your symptoms for me?
Mr. Darden: Oh Jesus, do we have to? The more I think about it, the worse my head throbs.
Dr. Balis: So you've been having headaches?
Mr. Darden: Not really headaches, per se. I've been feeling really disoriented. It's not constant, which throws me off even further. I'm okay for a couple minutes, then suddenly, I get this shot of pressure radiating from the back of my neck into my head. Then I begin to feel off balance and on the verge of fainting.
Dr. Balis: Tom, I think we need to discontinue the Prozac. I'm afraid it may be directly related to your recent physical illness.
Mr. Darden: And miss all those elaborate dreams and nightmares I've been having? I don't know. That's the most entertainment I seem to get lately. It would be a shame to lose that.
Dr. Balis: Are you having nightmares also?
Mr. Darden: They're not nightmares to me, but they're not exactly joyful experiences.
Dr. Balis: Can you describe some of them?
Mr. Darden: Do you really want me to go over yet another one of my dreams?
Dr. Balis: I'm more interested in the sensations than the content of the dream itself.
Mr. Darden: Really? Because I feel the same way. I don't really care too much about the plot line, just so long as I achieve the end result.
Dr. Balis: The end result?
Mr. Darden: The physical reaction that I experience toward the end--the climax, if you will.
Dr. Balis: Describe what you mean by that.
Mr. Darden: Well, these types of reactions to certain nightmares have been happening to me long before I ever started taking your medication, Charles.
Dr. Balis: That's fine. I'm still interested in knowing what those reactions are.
Mr. Darden: All right. It's really difficult to explain. I stopped having nightmares back in college. Well, okay, that's not exactly true. What I mean to say is that I stopped regarding nightmares as nightmares. They eventually became almost enjoyable to me.
Dr. Balis: Why is that?
Mr. Darden: From a very early age, I've believed that dreams are somehow a gateway to another world--a world that is always around us, very active and bustling, but one which humans can't normally sense while conscious.
Dr. Balis: Oh?
Mr. Darden: I'm on to something big, Charles. I've always struggled through life trying to figure out what purpose I have, what point there is for my being here. And now, for the first time ever, I feel I have a sense of understanding. The physical reaction that I have to nightmares is intense, Charles. At the very point where my heart rate shoots up in fear, something very horrifying and very beautiful happens. I feel pressure at the base of my skull, along with sharp, tingling sensations down my neck. And then...
Dr. Balis: Yes?
Mr. Darden: Something truly extraordinary happens. My consciousness seems to pierce through into that other world. I begin to hear a jumble of voices, all strung together tightly, all speaking rapidly and urgently...
Dr. Balis: What do those voices say?
Mr. Darden: I don't know. God dammit! I'm so close. But I can't make out the words just yet. They're all speaking too fast. I get the sense that it's important, that what they are saying is something profoundly meaningful and direct.
Dr. Balis: Are they speaking to you directly?
Mr. Darden: No, not at all. It's like I've tuned into a radio talk show that's been going on for quite some time. It's like I've finally found the right frequency. What's intriguing about it is that once I start hearing the voices, I'm wrenched with a concentrated rush of adrenaline. Every time I experience this, it's very clear to me that I'm not meant to hear them, that I don't belong there, and I've somehow penetrated this world against all natural laws.
Dr. Balis: I've never heard you speak this way before.
Mr. Darden: What way is that?
Dr. Balis: I've never heard you speak with such conviction. I'm not sure what to make of what you're describing to me.
Mr. Darden: I'm scaring you, aren't I?
Dr. Balis: I won't pretend that I'm not concerned.
Mr. Darden: This is very real, Charles. This has been happening to me for years, but I think Prozac has made them occur more often and more intensely. No one to whom I've described these dreams has ever had a common frame of reference from which to pass judgment on my experiences.
Dr. Balis: You say these physical reactions to some of your nightmares have been going on for years. Have you ever told a doctor about them?
Mr. Darden: Yeah. The guy I spoke to several years ago pretended to know exactly what I was going through. He called my experiences "night terrors." He said that it was some kind of sleeping disorder, but he never treated me for it. He seemed surprised that I looked forward to them, though.
Dr. Balis: Can you recall your first experience with these night terrors and what the dream itself was about?
Mr. Darden: The strange thing is that these dreams really are vague and sometimes have no subject matter at all. Something will be happening in the dream that's very benign. And then something someone says will somehow--and quite suddenly--trigger this intense feeling of fear. Like one time, a guy in my dream said to me, "Tom, I'm going to the grocery store. Do you want anything?" And immediately, I was struck with fear by what he said. And then the fear got so intense that I seemed to reach a climax accompanied by the rapid jumble of voices.
Dr. Balis: Hmm.
Mr. Darden: The very first experience that I can remember was a rather horrifying dream. I remember waking up from a terrible nightmare and looking around the room, thankful that I was awake. Only I wasn't awake at all. Just as I realized that, I suddenly heard a deep, demonic laugh slowly echoing from an unseen being in the room. And then I suddenly felt the dramatic feeling of fear that culminated in a cacophony of jumbled voices and the physical symptoms I've described earlier. Finally, I awoke--for real this time. And when I looked around the room, it looked exactly like it did when I thought I had awakened from the nightmare the first time. Everything was the same: the clock radio was in the same position on my nightstand, the blinds were opened the same way...everything was just as it was. It was as if my eyes had been opened during my nightmare and I had actually seen my true surroundings.
Dr. Balis: It's very possible that you did have your eyes open but were still dreaming. Sleepwalkers have been known to do it. They can have conversations with people who are awake and walk about as if they were fully conscious, but they usually have no recollection of having done so.
Mr. Darden: Sometimes, I just think that these voices truly mean something, like they are more than just a product of night terrors. Every single time I have one of these episodes, I consistently hear the voices. They are always there, despite the fact that the subject matter of the nightmares themselves have absolutely nothing to do with one another. The voices are the only constant. So when I start to hear the voices and then wake up from my nightmare, I immediately try to get back to sleep to return to the voices.
Dr. Balis: Are you ever successful?
Mr. Darden: Yes, but I can only hear them for a few seconds. And sometimes, I manage to reproduce the physical response to a nightmare even when I'm fully awake.
Dr. Balis: Really?
Mr. Darden: I don't know how the hell that's possible, but I can do it. I just can't seem to recall the voices at will.
Dr. Balis: When you say that you feel these voices are more than mere products of your night terrors, what exactly do you mean?
Mr. Darden: I don't know how to describe it to you without sounding religious. Believe me, I don't have a God-fearing bone in my body. I believe in God about as much as I do in the Easter Bunny. Yet, I somehow allow myself to believe that these voices are part of something beyond human comprehension. I feel they come from something that naturally occurs in the universe, but I can't begin to tell you where they come from or what their purpose is.
Dr. Balis: Is that a satisfying feeling--that the voices are beyond our comprehension?
Mr. Darden: I suppose so. It's comforting to me. The voices make me feel like there is something out there that is far more important and grandiose than our mundane existence. Jesus, I'm really starting to sound like a fucking religious nut now. I don't know how to adequately explain these feelings, Charles.
Dr. Balis: That's all right, Tom. It's very clear to me that this is important to you. I'm really rather surprised you hadn't mentioned this sooner.
Mr. Darden: How was I to bring something like this up? It sounds too damn unbelievable, and I feel like a flake even now, trying to articulate my experiences.
Dr. Balis: You've done a very good job so far.
Mr. Darden: Well, shit. Thanks so much, Doc. Just do me a favor and don't dismiss these as merely night terrors.
Dr. Balis: Very well.
Mr. Darden: You say that with such sincerity and without a shred of patronization. So now that I'm off Prozac, do you have any other plans for me?
Dr. Balis: Well, would you feel comfortable pursuing another type of medication?
Mr. Darden: I don't know. So far, finding the right drug has been sort of a crap shoot.
Dr. Balis: Usually it is. It sometimes takes a bit of experimentation to find the right drug and dosage that's appropriate for a particular person.
Mr. Darden: Well, I guess I'm game for it.
Dr. Balis: All right. What I'd like to do is start you on Zoloft, 20 mg. once each morning. We'll do a six-week trial just as we did with the Prozac. We need to wait about a week before you can start the new medication, to allow time for Prozac to leave your system. But if your headaches persist, please tell me right away and I'll refer you to a specialist, all right?
Mr. Darden: Okay.
Dr. Balis: Here's your new prescription. I'll see you in two weeks.
Mr. Darden: Cool.
Dr. Balis: But call me if...
Mr. Darden: Sure, Doc. Sweet dreams.
Dr. Balis: Very funny. Goodbye, Tom.
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