Charles Balis' Journal for the Week ending 05/22/98

Saturday, May 16, 1998

Sunday, May 17, 1998

Monday, May 18, 1998

10:30 am. Telephone Call with Nicole Ulreich. I had an odd telephone conversation with Nicole. I guess she was calling primarily to let me know that she was going to miss her appointment today because of her mononucleosis. But we flitted through a variety of subjects before Nicole abruptly ended the conversation. We spoke of Nicole's success in winning her student government elections, her unhappiness with having contracted mono and how it has limited her freedoms, especially her social interactions with her boyfriend. Angie's grandmother believes that Nicole was responsible for Angie's drug use and so has forbidden contact between the two. Nicole thinks that's especially unfair because Angie introduced Nicole to drugs, rather than the other way around. We also spoke about Nicole's first stepfather. He has been married five times--Nicole's mother was his second wife. Apparently, he had a daughter, Kerri, with his first wife. Nicole, who has contact with Kerri, said that her stepfather's first wife was a prostitute. Nicole expressed surprise that Kerri is so normal, given her family background. Nicole said that Kerri's father still sexually abuses her, even now that she's 17 years old.

4 pm. Fifteenth Session with Olivia Stillwell. Olivia began the session by talking about a vacation she's planning imminently to Washington, D.C. and the surrounding area. Then we started to talk about Olivia's list of issues that she'd like to address in therapy. First on her list was her perception that people don't seem to take her seriously--"people" mostly meaning her father. Olivia sees herself as a bubbly person, but thinks that others may view her as a "ditz." I told her that working at SII, away from the company her father owns, seems to have improved her sense of self-assurance, and she agreed. Disregarding Olivia's agenda for a moment, we began to speak about Olivia's family. Olivia immediately clammed up. She's definitely ill at ease talking about her feelings respecting her mother's death--she tries to deny that it has any emotional relevance to her present. I pressed a bit, but let up when she promised that she'd think about it before the next session if I changed the subject now. The next item on Olivia's agenda was her concern about not being involved in a romantic relationship. She framed it as concern that her standards are too high. She said that she was concerned that she was going to be an old maid. When she made a reference to masturbation, she was extremely embarrassed and I changed the subject. Previously, Olivia had told me that none of the men she had dated made her feel particularly amorous. She still agrees, although Jordan clearly has kindled some of those feelings. She thinks of relationships as investments that can go sour, and expressed hesitation about getting involved unless she knows they're a sure thing. I urged her to think of relationships as a learning experience--even from those that fail, you learn something that will assist in the next relationship. At the end of the session, Olivia spoke with envy about an executive at SII who just dates--I believe she was referring to Katherine Lippard. Olivia agreed to continue therapy on an alternate week schedule.

Tuesday, May 19, 1998

2 pm. First Session with Logan Marcas. I was uneasy when I received the message from Malcolm Spunt that I was to evaluate an employee involved in an altercation and make a recommendation to the company as to whether or not to retain him. My orientation has always been as a doctor for a patient, rather than as some company oracle to make decisions about employee fitness. However, I acknowledged that the company did have a dilemma, and I felt I had no reasonable alternative. I was told that Mr. Marcas, a recent hire to the newly created post of co-director of security, had assaulted his co-director, Ms. Brenda Wolfe, during a meeting. Apparently, he injured her severely enough that she required hospitalization. I was also told that he was an exceptionally talented young man whose services were very important to the company. Mr. Marcas came across as very professional during our session. But he also seemed emotionally detached. While he professed remorse for his actions, he clearly was trying to tell me what he thought I wanted to hear. What was uppermost on his agenda was having me sign off on his competency to return to work. He described with a certain crisp efficiency the actions that he took in assaulting Ms. Wolfe. He didn't try to minimize what he had done, describing in detail the exact movements that led to her injuries. He didn't overstate the magnitude of Ms. Wolfe's provocation, either. In fact, his description of what she had done to trigger his violent response was all about her attempting to block his access to a file during a meeting, not anything to do with her motivations and intentions. When I asked Logan about whether Ms. Wolfe felt threatened by the fact of his hire, he refused to speculate on what she might be feeling. I got the fleeting impression that Mr. Marcas might not even acknowledge the existence of other people's internal emotional states, but I may be reading too much into what may just have been his attempt to be guarded in his responses. His presence was very commanding yet calm. He had a deep, mesmerizing voice--perhaps he would make a good hypnotist. During the session, I felt I was being evaluated. He seemed very focused and never really took his gaze off of me. Most patients look around the room, especially while they're talking. Mr. Marcas just kept looking directly at me, even as he responded to my queries.

Wednesday, May 20, 1998

5 pm. Forty-Sixth Session with Alex Rozzi. Alex was noticeably improved this session. He didn't have the familiar dark circles under his eyes and he seemed in much better spirits generally. He was even a little playful. He went for a drive with Regina and then found out that she had discovered what almost happened between Camille and him. As Alex predicted, Regina didn't take it well. She stranded Alex somewhere on Devil's Slide, just South of Pacifica. She forced Alex out of the car and then drove away. Alex realized he was holding onto Regina's purse, so in retaliation, he disposed of the contents. He made his way down to a nude beach that was nearby and befriended a gay couple there. They spent a few hours on the beach and then drove Alex home--with Alex warding off the older man's obvious sexual interest. Alex seemed to vaguely like the younger man who Alex said runs a candy store on the Peninsula. Alex and Luke are back together--at least they're going dancing together, even if they're not currently engaging in sex. Luke said that he forgave Alex, especially after he realized the extent of Alex's concern about him when he was apparently missing. Alex said that he's too confused to have sex right now, and that was okay with Luke. I remember Luke also understood about Alex's lack of interest in sex during the time before Benny's trial. We started to talk about Benny, and although Alex is making progress in putting those issues behind him, he still feels that his time with Benny haunts him. He keeps rehashing the events, trying to reconcile his sense that Benny loved him with some of the things that Benny actually did. I told Alex that I believe that Benny is a sociopath. Alex told me that Benny was sentenced to 7 years in prison, but with time served and good behavior, he could be out substantially sooner. Alex told me that Tony was going to Rational Recovery meetings and smoking marijuana at the same time--Tony tries to dismiss smoking marijuana as not being the same as using drugs. Tony also wants Alex to accompany him to the meetings, and I suggested that it might not be a bad idea. At the end of the session, Alex wanted me to crash his mother's wedding and meet his cousin Rosemarie, whom Alex thinks would be perfect for me. I declined.

Thursday, May 21, 1998

2 pm. First Session with Samuel Eldrich. I met today with Sam Eldrich, a boy almost 18, who's about to graduate from high school. Sam is troubled by depression and self-loathing, giving rise to suicidal ideation. I don't believe that Sam is an imminent suicide risk--he doesn't appear to have any fixed plan. Sam was emotionally labile, crying frequently during the session. He seemed to have a diminished ability to concentrate, although he seemed to improve towards the end of the session. He presented signs of psychomotor agitation with repetitive nervous features--drumming his fingers and pulling at his shirt--and he complained of persistent fatigue. His speech was rapid, and given in a high-pitched staccato whine. And, of course, he suffers from recurrent suicidal ideation without specific plan, combined with feelings of worthlessness and excessive and inappropriate guilt which seems almost delusional in character. He was also able to laugh and joke at times, which is somewhat atypical of patients suffering from depressive episodes. But I am concerned that the apparent trigger--Sam's bereavement over the death of his grandfather and his inability to care for his grandmother--masks a clinical depression. I saw no evidence of bipolar mania so I'd guess his depression is unipolar. The med school mnemonic was "Depressed I Was Stuck Memorizing Extremely Grim Catagories of Sickness"--Depressed mood; Interest; Weight; Sleep; Motor activity; Energy; Guilt; Concentration; Suicide. The mnemonic came in handy while listening to Sam. I want to conduct a suicide assessment of Sam during our next session. If I'm wrong and he is an imminent suicide risk, I must consider an involuntary commitment. But currently I'm leaning towards taking a somatic approach--possibly fluoxetine.

4 pm. Eighty-First Session with Anna Green. Kathy is still living with Anna. Since they are living together, they've had an opportunity to become confidantes. They are close enough, in fact, for Kathy to make a confession to Anna. When Kathy got pregnant, it was not with Martin's child. Kathy confessed to a long-standing sexual relationship with a black man who was a dominant "slave master." Kathy described him as very powerful. After Kathy got involved with Anna and Martin, she decided not to have sex with this man anymore, but would still engage in S&M play with him. Apparently, similar expansions on the normal rules of monogamy are common among the S&M community. Kathy had a session with this guy sometime in late November. As she tells it now, he took her back to his place, and they had what Kathy described as an intense session together. When Kathy told him that she had to go, he wouldn't let her leave. Even though she repeatedly said that she had to go and was tired, he kept pressing her. Kathy said that she couldn't say no to this guy. They ended up with Kathy, terrified, first performing fellatio and then engaging in intercourse. Kathy said that it wasn't her idea, it just happened. Kathy has been avoiding him since. Anna described the incident as a rape, but I'm not sure if it meets a legal definition of rape. It seems a close call to me. Within the S&M community, the norm is that the parties will negotiate in advance the permissible activities within a session, but my understanding of the law respecting rape is that Kathy has to communicate her lack of consent. Since they previously had a sexual relationship, and since Kathy said she couldn't say no to this guy, I think it is possible that he didn't know that he didn't have at least her implicit consent to sex. While perhaps not meeting a legal definition of rape, I think what this guy did was outrageous. He clearly took advantage of Kathy and used her helplessness as his submissive to accomplish these sex acts. At any rate, Kathy had the amnio test and apparently it was fine--there was no indication that the baby had Down's syndrome. But she also found out through the child's blood type that Martin could not have been the father. She knew that the baby's coloration would reveal her infidelity if she gave birth, so she said that the baby had Down's syndrome and had an abortion. When Martin found out that the baby did not have Down's syndrome, he was furious that she had gone ahead with the abortion without consulting him. Kathy couldn't tell him the truth--at least that's what she thought. At the time, I thought Kathy's actions were bizarre--the baby seemed to be her route to power and aborting it when it didn't have Down's syndrome seemed contrary to her interests. Now I understand. Anna doesn't seem to see any need to tell Martin any of this, and Kathy told her about this in confidence. Indeed, Kathy is getting Anna more deeply involved in her mental landscape. Kathy is working on Anna's sympathies. Kathy's pain over the whole issue may be genuine, but the end result is that it will be much more difficult for Anna to separate herself from Kathy.

Friday, May 22, 1998

10 am. Eighteenth Session with Sharon Lough. Sharon was in a foul mood today. She told me that Rob had arranged to get a divorce from Charlotte amazingly quickly--Sharon said that he went to a quickie divorce place and apparently Charlotte agreed to the proposed property settlement. I remember that Sharon told me once that Rob would never divorce Charlotte. Now, he's apparently found the courage, probably buoyed by his relationship with Sharon, to sever that relationship. However Sharon doesn't see it that way. Rob has allowed Charlotte a little leeway in getting her belongings out of the house over a period of a week, and Charlotte has said that she doesn't want to see Sharon there while she's packing. Sharon is livid. She is being inconvenienced in having to move out for the week, especially outrageous in her opinion because of her foot which was crushed by Charlotte's car. Mostly, Sharon faults Rob for being spineless because he considered Charlotte's needs over her own. Sharon said that Charlotte has informed those neighbors who were her friends that Sharon betrayed her and schemed to break up her marriage. Now those neighbors give Sharon dirty looks. Sharon doesn't like to be cast as the evil "other woman," especially when she's in her relationship with Rob only for the financial benefits, which she finds meager anyway. Sharon believes that it was always Charlotte's intent that Sharon have sex with her husband so that she wouldn't have to. I pointed out to Sharon that it was her idea to make good on the sex for barter arrangement. Sharon angrily said that it didn't matter whose idea it was--she knew that Charlotte wouldn't care. Respecting Rob, Sharon acted like a jealous, hurt lover even as she vilified him and told me how much he disgusted her. Sharon fantasized about how bad he'd feel if she left him. Sharon also said that she needed "a good fuck" and she indicated that she was considering entering into a sexual relationship with Tony, the guy she met at rehab. It just struck me--the Tony that Sharon is talking about couldn't be Alex Rozzi's Tony, could he? Alex said that Tony was going to Rational Recovery meetings, too. It must be just a coincidence--there must be dozens of guys named Tony going to Rational Recovery meetings in the city right now. And besides, Alex's Tony is gay. But I think Sharon said something about once about suspecting her Tony was gay, also. Well, Sharon is looking to Tony to perhaps fulfill her sexual needs and, incidentally, get herself a place to live while Charlotte removes her belongings.

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