Charles Balis' Journal for the Week ending 10/24/97

Saturday, October 18, 1997

Sunday, October 19, 1997

Monday, October 20, 1997

11 am. Telephone Call with Sgt. Tracy Keefe of the SFPD respecting Mr. Peter Hossfeld. I got a call from Sgt. Tracy Keefe of the San Francisco Police Department. Apparently, Peter went into the police station on the night of the full moon and confessed to a crime involving murdering a woman by savaging her with teeth and claws. He asked to be locked up before he murdered again. The police complied and tested him for blood stains, but there were none. When no body turned up, they started to doubt Peter's story. The department psychiatrist is apparently booked a week in advance, so when they found out that Peter had been under a psychiatrist's care, they called me. The detective was looking for my assurance that Peter wasn't a societal risk, which I couldn't give, although I did express my opinion that the "murder" was probably just a fantasy. I did request an opportunity to see Peter and the detective said he would comply. In fact, he was quite happy to hear that Peter had private insurance and liked the thought that I might be able to talk Peter into a voluntary commitment at a private mental health facility. If Peter resists a voluntary commitment, I think I now have enough to insist on an involuntary commitment if necessary. I'll await the detective's call.

Tuesday, October 21, 1997

1 pm. Third Session with Rachel Tanner. Rachel lost her job doing nails in a salon, perhaps as a result of her OCD. Rachel believes that her thinning hair made the salon owner feel that Rachel was not projecting the right image to her customers. I suspect that it might go far beyond that and that Rachel's compulsions are interfering with her ability to function. I'm quite fond of Rachel and I would like to be able to free her from the confines of her disease. She's obviously very bright and she's trapped beneath the burdens imposed upon her by her rituals. She told me that she feels that if she doesn't take a number of steps which is a multiple of five, that she can cause some harm to come to her brother Michael. I know that I'm not going to have any particular success in trying to stop the ritual itself, but I thought that I might be able to disassociate the ritual from the guilt. So I had Rachel record a superstitious statement that sounded silly even to Rachel as she said it, and asked her to play the tape several times daily--I'm hoping that intellectually she'll find herself rejecting the statement with more and more fervor even though emotionally she'll still feel as if it has validity. The fact that she is losing ability to function because of her compulsions gives a certain impetus to my decision to begin a somatic trial lasting at least 8 weeks on either clomipramine or a serotonin reuptake inhibitor. I think the likelihood of the best short term result is with clomipramine, but I'm concerned about the sedative potency of the tertiary amines. Therefore, I'm leaning towards fluoxetine. I'm going to prescribe 20 mg. of Prozac, once each morning. Warn Rachel to report any transient nausea, vomiting, insomnia, and agitation or nervousness. I've never talked with Rachel about her sex life, but fluoxetine poses a potential for sexual dysfunction including anorgasmia, although rare at the low doses with which I'm starting. I must caution Rachel to have realistic expectations for somatic treatment. Even after a successful trial, most patients with OCD still have substantial symptoms. And a full response to the medication can take months. In the sessions to come, I'd like to concentrate on understanding Rachel outside of the effect of her OCD, and I'd also like to try to understand the psychological underpinnings that led Rachel to escape into the comforting predictability of her rituals. I think it is clearly related to her mother's death, but it also seems possible that some of the answer is locked up in her experience with school. She was a good student until her mother's death, and thereafter, she shunned education. When I suggested that she might consider going back to school now that she is unemployed, she had a strong negative emotion reaction--dismissing the suggestion out of hand in a way atypical of her usual anxiousness to please. I allowed her to abruptly change the subject, but we'll have to return to it and discover the reasons that make the subject so charged with emotion.

Wednesday, October 22, 1997

4 pm. Twenty-Second Session with Katherine Lippard. Katherine came back from her trip to Maryland. She made a connection with her brother, Joey, and his snobby wife, Rachael. The three siblings--Phil, Joey, and Katherine--had a chance to spend a late night together getting caught up on their lives. There was a fancy party where Katherine got to use her corporate skills and Phil made a hit by playing the bohemian, and there was a family cookout where even Rachael seemed to unbend a little. Katherine's mother has a boyfriend named Gary, with whom she's happy--but isn't interested in increasing her commitment beyond dating. I didn't bring it up, curious to see if Katherine would herself, but Katherine never mentioned the results of her interrogation of her mother. The trip did give Katherine a chance to refresh her southern accent, which is now much more pronounced than when she went away. But Katherine had been hoping that the vacation would refresh her and bring her out of her feeling of general dissatisfaction with her life. It didn't. Katherine said that Jake was glad to see her when she got back and was more overtly affectionate. I said that was a good thing, but Katherine indicated that she wasn't sure. When Katherine said, "Our time is about up" at the end of the session, I thought for a moment she was talking about her relationship with Jake. She had something else to say, but swallowed it and said that she'd save it for next week.

5 pm. Twenty-First Session with Alex Rozzi. Alex's relationship with Luke is progressing quickly into something serious, but Alex is afraid of disclosing his problems with Benny. He's worried that Luke will shy away from someone with the type of problems that Alex has. I, of course, counseled honesty. Benny has acquired private legal counsel and is seeking psychiatric examinations which will delay the proceedings--and frustrate Alex whose strong desire is to testify and get on with his life. I was surprised that Alex talked about his relationship to Luke with Ralph. Alex said that Ralph approves of his relationship with Luke. I expected that Alex would keep the relationship secret from Ralph--I suspected that Alex and Ralph were still physically involved, even though Alex hasn't talked about that with me since the days when Ralph was getting Alex to roll around naked on buttered slices of bread. Alex met with Jake who seemed to like his artwork. He's hanging two paintings up in the gallery and gave Alex some numbers of people to talk to for art services, including one outfit which matches illustrators with children's book authors. Alex is very enthusiastic, although perhaps just a bit wary.

Thursday, October 23, 1997

4 pm. Fifty-Ninth Session with Anna Green. Anna, who was substituting for Kathy at the adult books store, described being the mistress of that environment. She played the part to the hilt, making it into a kind of S&M theater with Martin as the willing customer/slave. They created quite a stir as Anna ordered him around the store and forced him to lick her boots before an assembled audience of sex merchandise consumers. It must have been a scene. My previous experience with adult book stores led me to believe that people want to be left alone to find the erotica that interests them and to buy it as inconspicuously as possible. But Anna and Martin turned that notion on its ear, with Martin even allowing himself to be paddled by other customers looking to try out the merchandise. When Kathy came back, she complained that now her customers are going to be looking for repeat performances. But the difficulty of doing both Kathy's job and their own left Anna and Martin little time to experience what it was like just being a couple instead of a threesome. Anna plans to take Kathy and Martin to the Exotic Erotic Halloween Ball, each on leashes. She seems to be warming to her role as dominatrix, although I know that it is just because she has sublimated her own sexual desires to those of Martin's and Kathy's.

5 pm. Twenty-First Session with Christina Herald. Christina has decided that I need companionship and she has gone on a mission to make sure that I adopt that kitten, Clio. Great. I've become a charity case. She launched into a discussion about how wonderful her father's new dog is and how important pets are generally. She was becoming more and more puckish, until I called her on it and told her that I realized I was being set-up. Then she got this delighted, impish grin and told me knowingly that I must need companionship. She left me a photo of Clio, apparently for my deliberation. In the photo is just the tail of this other peach-orange cat that apparently Bessa is adopting. Christina's pregnant student dilemma seemed to resolve itself in a rush, with the parents ending up more supportive than anyone had guessed. The student plans to have the child and then put it up for adoption. But the girl's brother is apparently bad news, and he's targeted his sister's boyfriend for some calamity. Christina was worried about her student, but clearly not so wound up by the situation as she was last week. Christina's real complaint is that she finds herself without a boyfriend now, although she professes to be picky and says that she doesn't mind waiting. But she describes her hormones as going on a rampage.

Friday, October 24, 1997

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