Charles Balis' Journal for the Week ending 08/14/98

Saturday, August 8, 1998

Sunday, August 9, 1998

Monday, August 10, 1998

11 am. Initial Session with Madeline Trent. Although it is my professional obligation to do so, I'm finding it very difficult to separate Madeline Trent the patient from Maddie Trent, the wife of another patient. I was surprised, when I met Ms. Trent, because she didn't match the image that I had of her from listening to Jesse. I was expecting a simple, soft, somewhat fragile woman rather than the strong, sophisticated, and somewhat cold woman who came to my office today. Madeline's feelings for Jesse don't seem nearly as potent as his feelings for her. While she may have initially loved Jesse, she told me that she doesn't feel that he's grown in the relationship as she has. Madeline feels the weight of the responsibility in the family and it presses upon her. Apparently, she doesn't think that Jesse is carrying his share of the burden. Madeline is twenty-six. Physically, she's tall and slender, with very dark brown curly hair and bright blue eyes. Her fingers are exceptionally long and thin, like the rest of her. It would be impossible, just by looking at her, to guess that she bore a child less than three months ago. She carried a bottle of water with her and sipped it throughout the session. Madeline was dressed professionally and fashionably, in a businesslike skirt and blouse. Her hair was styled and dressed and her make-up was carefully applied. Her demeanor seemed crisp and efficient even when she shed tears, although she seemed much more vulnerable and human when she talked about Natalie, her baby daughter. Madeline's primary complaint was that she's suffering from unendurable stress. Much of that stress can be attributed to the difficulty of being a new mother combined with being a professional woman seeking career promotion. On top of those substantial stressors, Madeline has to deal with the fall-out from being sexually assaulted last year by a serial rapist. A suspect is in custody after allegedly murdering another woman, and Madeline is expected to testify at the trial--but as a witness for the defense. Although she believes the suspect is guilty of the assault against her, she can't identify him. The defense believes that Madeline will make a good witness for their side, even given her hostility towards the defendant. I can only imagine how that must make Madeline feel. Apparently, Madeline's attacker did significant damage to Madeline's reproductive system and, given that, Natalie's birth was somewhat miraculous and is unlikely to be repeated. And Madeline hasn't told Jesse all the details of the assault. Now she is required by law to testify to those details in a courtroom full of strangers. She said that she feels that she'd rather die than testify. Madeline is also afraid that if the defendant fails to be convicted, he could come after her again. While some of her fears may be overblown, I'm afraid that most of them have a fairly reasonable foundation in fact.

Tuesday, August 11, 1998

Wednesday, August 12, 1998

2 pm. Third Session with Kelly Wiseling. Even though I don't think it was Kelly's original intention, we spent the session talking about issues arising out of Kelly's deafness. Kelly instructed me on some issues involving deaf culture. Although she doesn't particularly feel a part of it, she can't deny its influence on her--she identifies herself as a deaf woman first and foremost. Using a simplistic set of generalizations, deaf culture seems to have a fundamental schism between assimilating with the hearing world on the one hand, and isolating themselves on the other. Kelly told me an anecdote about a deaf couple who wanted a deaf child. When in utero testing revealed that their child would have normal hearing, they sought an abortion. Although obviously an extreme example, this couple wanted a child who would share their fundamentally isolationist culture. Kelly occupies a strange place in the middle between the two extremes. Her mother forced her early into the assimilation camp but then, for college, insisted that Kelly attend Gallaudet, a bastion of the isolationist philosophy. So Kelly feels ill at ease in both worlds and somewhat ambivalent about deaf culture as a whole. Kelly spoke of Heather Whitestone and Marlee Matlin as deaf role models. She felt uncomfortable lionizing Whitestone because of the similarity in the way that both of them were brought up. Kelly believes that it would be like condoning her own mother's approach to her upbringing, which she's unwilling to do. Partly in reaction to the Collavito incident, Kelly's boss offered her the opportunity to circulate a memo instructing the hearing employees on ways to improve their communication with Kelly as a deaf woman. Kelly enumerated some of the etiquette issues of addressing her: how someone should get her attention and ways to assist her in reading lips when conversing. While Kelly initially rejected the idea--she doesn't like calling attention to herself in that way--the idea is now growing on her. I urged her to consider it--I think it would break a lot of barriers caused primarily by other people's unease in not knowing how to approach Kelly.

5 pm. Fifty-Eighth Session with Alex Rozzi. Alex is still acting as Ralph's primary caregiver and Ralph has completed an initial round of chemotherapy. Ralph's usual good humor is wearing a bit thin. But Ralph told Alex that, if he dies, he wants Alex to have the house and its contents together with his cars. Alex has always blamed himself--or some quality within himself--as the cause when relationships terminate. This is true even when the obvious reason for the separation is death, such as when Alex's grandparents died. Alex's pattern of self-blame seems likely to be repeated if Ralph dies. I noted during this session that Alex's feeling about Ralph's demise are strongly linked to the sense of abandonment he felt when Benny terminated their relationship suddenly. The pain of that sudden cessation of relationship hasn't left Alex yet. He told me that he had a Tarot card reading which gave him permission to forget about Benny and start fresh. But it's the lack of closure that he feels with his relationship with Benny, even given all that happened subsequently, which keeps him from being able to forget him. Alex told me that Benny tried to flatter Alex into appearing in porno movies. Benny apparently had some ties to people who produce that sort of thing. Although Alex was pleased with the complements at the time and considered doing it, he's very glad now that there aren't tapes for sale showing him engaging in sexual activity. Of course, while Benny was recommending this course of action, he was also covertly taping his own sexual liaisons with Alex. All the while, Benny was disingenuously espousing his philosophy of "pushing the envelope" in all aspects of life. Benny is definitely a piece of work. But Benny seems to have had some luck by escaping prosecution for last year's murder of the man who assaulted Alex. Apparently, the coroner's report was inconclusive on whether or not the man's death was a homicide. The man died of a skull fracture that could have been sustained when he used his head to butt Alex's head. So the district attorney's office has declined to prosecute. And Alex's born-again cousin Mirdle contacted social services to turn in Alex because of his living arrangement with Ralph. But Alex's mother told the social worker who came to the house that Alex was providing healthcare services to an old family friend, and the agency bought it.

Thursday, August 13, 1998

10 am. Fourth Session with Nina Alvidrez. Nina described a feeling of hopelessness and loneliness at work. She says that she primarily communicates with her boss, Tom Utterman, through e-mail. He's brusque and doesn't seem to have time for her. As she sees it, he feels she isn't worth the time, even though she's on his staff. In previous sessions, Nina has expressed the wish that she could work at home and minimize her contact with others. Given her general desire for social isolation, I thought it a bit odd that she should crave attention from her boss, but she clearly does. Rachel told me that she has some current suicidal fantasies involving throwing herself from SII's roof. But her suicidal ideation fortunately doesn't rise to the level of a plan of action. Rachel told me that she had an episode two or three years ago in which she intentionally mutilated herself with a pair of scissors. Her parents went against the hospital's advice and refused to have her admitted into a psychiatric facility. Instead, they embarked on a 24 hour watch program--"babysitting" is how Nina thought of it--carried out by the members of her family. However, since that time, her family has never discussed the incident, as if they were all pretending it never happened. It was Nina's sister Maria who discovered Nina after the mutilation. Their relationship has never been the same since. While Nina only brushed upon the emotional issues which allowed her to become self-destructive, she did describe a feeling of depression which begins by rendering the world humorless and then causes her to feel detached from herself. A deep sense of sadness--which Nina describes as "darkness"--overwhelms her. She still feels this way occasionally and her mother has come to recognize the warning signs by Nina's penchant for taking long, very hot showers during these episodes. Nina said that she's not close to feeling that way now, and she promised to let me know if she did. Next session, I'd like to formally evaluate Nina for clinical depression and perhaps recommend a somatic approach as part of her treatment.

4 pm. Ninetieth Session with Anna Green. Anna has been suffering from difficulty in initiating sleep. Apparently, it's been going on for some time and she looks physically exhausted. She's also becoming depressed and somewhat despondent because she isn't currently in a relationship and has been functionally celibate for the last seven months. Anna was asked to participate in a police line-up. She thought she recognized two of the participants from S&M events. While the police have been quite close-lipped to Anna herself, her father seems to be getting more information. He was told about the incident in late June where a young man committed suicide about a week after a session where Kathy played the dominatrix for money. Apparently, the police suspect that Kathy's assailant may be the young man's father. Although I didn't speak to Anna about any of this, I find that theory somewhat unlikely, unless the grieving father was predisposed to sex crimes generally. A simple assault or even murder would be more likely than the crime Kathy suffered, if revenge and anger were the motive. Although rapists' motivations are complex and not easily generalized, rape is not often a crime of anger or revenge. Although Anna has been less than fully truthful with her father, he has now taken on a very active role, which Anna welcomes. He is communicating with the police regarding the investigation, and he has notified his friend, the professor, who owns the house that Anna is living in, about recent events in his home. Anna told me that most of the professor's prized collection of S&M paraphernalia has been confiscated by the police. The professor and his wife have decided to extend their European tour to avoid coming back in the middle of the police's investigation. Anna fell back on her old habit of making sexual overtures towards me when she feels unhappy with her current romantic situation. But they were half-hearted. Given her current situation, Anna is unlikely to make a connection with a man who'd be particularly good for her. Although I offered to prescribe some sleeping aid, Anna refused.

Friday, August 14, 1998

10 am. Twenty-Ninth Session with Sharon Lough. Sharon was in an almost violent altercation at my office door. Apparently, some man ran a stop sign and Sharon took offense. She saw him park and then she scraped her key along the side of his car, scratching the paint. He followed her up to my office, with both of them cursing at each other all the way. When Sharon spat full-on into his face, I intervened. I dragged Sharon inside the office and told the man to leave or I'd call the police. It is an obvious understatement to say that Sharon is having a great deal of trouble dealing with her hostility. I gave her a taped exercise in guided relaxation in an attempt to teach her some skills that she can use to avoid the types of violent confrontations that she's recently found herself. Sharon made a number of strong sexual hints towards me which I pointedly ignored or tried to defuse. However, I have to be careful. I don't think that classical transference or any particular sexual interest in me really explains it--perhaps Sharon's previous modus operandi was to reward with sexual favors those who were of service.

3 pm. Sixteenth Session with Rachel Tanner. Rachel's relationship with Carla is developing depth. Rachel tried to kiss Carla and couldn't. She threw up instead. But that lead to a frank discussion with Carla about Rachel's battle with OCD. Carla seemed patient and caring. She also seems more than willing to help Rachel through her difficulties with intimacy. Rachel has a host of concerns, most of them are typical for someone starting a new relationship and for someone unsure about their sexual orientation. I see my intervention into those issues as less important than into issues which arise out of the OCD. For example, I'm not certain that Rachel's sexual orientation is really exclusively directed towards women. That would be inconsistent with the sexual fantasies she described as revolving around her brother's roommate. Rachel has very little experience with sex. But she's clearly enjoying the onset of sexual intimacy with Carla, and Carla appears to have the patience to awaken Rachel's sexuality. I wouldn't be surprised if Rachel outgrows Carla and uses what she's learned in that relationship to take on a heterosexual relationship. Of course, I could be absolutely wrong on that point--it's really just a hunch. I pointed out that Rachel was making remarkable progress in her willingness to undertake new experiences--that's a considerable understatement! I also noted that her nails now are less ravaged than at any time since she began seeing me. Rachel is thinking about moving out of her grandmother's home and getting a job, preferably on campus. Rachel also told me that she and Michael had worked over the last year on a memorial service for their mother to commemorate the third anniversary of her death. The memorial service was emotional for Rachel but perhaps it helped bring her some sense of closure to her mother's death.

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