Thursday, April 10, 1997
10 am. First Session with Decker Jenkins. A new patient who called me up out of the blue without a referral came in today. Decker's physical complaints are headaches and some slight blurring of his vision. But he seems to be a very complex young man. He just turned 26, but seems young for his age. I'd describe him as handsome, with thick, dark hair worn long. His hair was greasy, although he didn't have an obvious body odor. His features are strong, with his bushy eyebrows connecting together in the middle. Overall, he frequently has a somewhat menacing look. He is a bit underweight, but not seriously. He dresses in old, faded, casual clothes. Decker works as a bartender, which I found surprising due to his strange social mannerisms. For example, during the session, Decker found it difficult to look at me directly, either while I was speaking or while he was. He also physically sat on his hands during the session, making no hand gestures at all. It seemed as if someone had trained him not to use his hands while speaking by forcing him to sit on his hands, although he didn't mention anything about that. What he did briefly describe was a fairly odious childhood, although he is not fully conscious of just how bad it was. His mother is named Karen and apparently she beat him for addressing her by the title of "Mother" or "Mommy". Decker wants me to call her Karen even in our session--he has been conditioned to cringe when he hears her addressed as his mother. Decker was the unwanted product of a union between Karen and a one-night stand. Decker has negative fantasies of his father as a liar and a cheat. He was also beaten for asking Karen about him. He also mentioned being left alone for several days at a time as a young child while Karen went off with her latest sexual partner. Decker was worried that I might try to institutionalize him. His picture of mental hospitals comes from Kesey's "One Flew Over the Cuckoo's Nest." It's kind of like developing an image of dentistry from "Marathon Man." I tried to reassure him, but the issue is going to be hanging over our interactions for a few sessions. Decker told me that he believes that he has a problem in over-analyzing things. He finds his mind racing as he searches for answers to all the questions that occur to him. He believes that the answers are there in his mind somewhere, if only he could search them out. He said that he is obsessed with using the untapped potential of his brain. Decker described an almost mystic figure in the form of a friend named Simian. Simian was an old man when they first met 14 years ago, so he must be quite ancient now. Simian was the one who directed Decker to seek out my help. He seems to act an adviser to Decker. Decker described first meeting Simian in what sounds like almost a spiritual encounter. Decker was extremely tense through our session. I told him to try to relax and to avoid trying to answer every question he wonders about. It's okay to not know all the answers all the time. We left the scheduling of appointments open. He said that he'd contact me later to set up our next one.

Friday, April 18, 1997
10 am. Second Session with Decker Jenkins. Although obviously I need more time to develop a fuller picture, Mr. Jenkins presents symptomology consistent with active phase Criterion A2 Schizophrenia of Undifferentiated Type. Simian, the friend which he had told me about during his last session, turns out to be a persistent auditory hallucination which keeps up a running commentary on this thoughts and actions. In my presence, Decker mentioned the possibility of suicide as a means of controlling the voice. Although I am extremely concerned, in my best judgement I do not believe that Decker means to imminently commit suicide, although I will conduct a suicide assessment in our next session together. For now, I thought it most important to try to get Decker on an immediate somatic course of treatment. I want to aggressively treat his psychotic symptoms, so I prescribed risperidone, 6 mg. daily. I've had good luck with the benzisoxazoles--they are potent with a relatively few extrapyramidal side effects. Even though the risk of tardive dyskinesia is relatively low with risperidone, I'm prescribing a prophylactic vitamin E therapy as well (1200 IU daily). Of course all of it is irrelevant if he doesn't take the medication. It seems that Decker really wants treatment, but Simian may not allow Decker to take the medication. If I can't convince Decker to take the medication, then I will have to consider getting a court order to have him committed until he stabilizes. Untreated, Decker has a poor prognosis indeed. Some observations during the session: Decker is quick to express emotion. When that happens, his entire body tenses and he often swears. Every time he swears, he freezes, looks directly at me (which is the only real eye contact I have with Decker during the session) and seemingly is fearful that I might physically punish him. Decker still sits on his hands during the session, forcefully preventing any hand gestures. However, he does use his feet to write imaginary designs or letters on the floor. Here, he is quite detailed. I noticed him crossing t's and dotting i's, although I couldn't read what he was writing. When he told me that he had his face ripped open with a belt by Karen, I noticed that he had a permanent scar under his right eye. Whenever he talked about women, I also noticed that he gets an expression of disgust on his face.

Monday, April 28, 1997
6:06 pm. Telephone Call from Decker Jenkins. Decker called in and apologized for missing his session on Thursday. He delayed beginning with the risperidone that I prescribed until just a few days ago because he was battling with Simian about a possible euphoric effect, but now he is disappointed because he doesn't feel any different. I advised him that it would take several weeks for the medication to take effect, and he seemed to accept that. Decker seemed calmer and more focused during this conversation than in our earlier sessions. Some people find it easier to concentrate on a conversation on the telephone rather than face-to-face because the telephone only involves one sensory input--sound--as opposed to the cacophony of impressions one gains in person. But I also sensed that Decker seemed less skittish somehow, and I'm not willing to ascribe it all to the telephone effect. Perhaps he got a good night's sleep. And Decker actually gave a ghoulish sort of chuckle when he joked about not killing himself yet. It surprised me that he could show that kind of perspective on his situation, although I have to say that I didn't find his joke very funny. I'm still planning on conducting a suicide assessment during our next session. Decker is getting some support from his employer, Mr. Knopff, who recommended that Decker seek my help. I'm very glad that Mr. Knopff has recognized this problem in his employee and, instead of just firing Decker, is actually helping him to get some medical attention. So often in these cases, employers decide just to terminate an employee rather than get involved.

Thursday, May 1, 1997
10 am. Third Session with Decker Jenkins. While I can't call the risperidone trial a success yet, I have noticed a significant change in Decker's affect. While still physically sitting on his hands, he is smiling and joking now, looking me in the eye and quite a bit more relaxed. When he swears, he no longer looks frightened, as if he's going to be punished. When he spoke of Karen--his mother--he was able to actually make a joke, where as before he could express nothing but anger and fear. I was surprised to find the extent of Decker's inexperience with women. He is still a virgin--although I presume as a bartender that he has had many opportunities--and his view of women has been completely colored by the horrendous relationship he had with his own mother. Decker is a misogynist, but he got that way mostly through fear of and a lack of emotional contact with women. He assumes that they are all versions of Karen. Except for one woman who he met last week--Christina. By the weirdest coincidence, this is the second time in a week that one of my patients has become romantically interested in one of my other patients, and neither of them involve contacts through SII. Decker told me about this girl who came into the bar and won his heart by ordering a double bock, which they didn't have. I remembered Christina Herald telling me how disappointed she was that some bar didn't have double bock. He then floored me by saying that her name was Chris. She talked to him in a friendly way at the bar, but I assume she has no idea of the conquest she's made. I conducted a suicide assessment of Decker and find that he is not a current suicide risk, although he clearly has latent tendencies which could become suicidal if untreated. Decker told me that he has held a loaded gun to his head at some time in the past, but decided not to pull the trigger because of the thought that the act would not free him of Simian, who would just follow him into the afterlife. Decker thinks of Simian as both a kind of devil and as the source of his courage. I'm concerned that some part of Decker will miss Simian if we are able to control the auditory hallucinations through the anti-psychotics. I asked Decker to try to keep a daily journal. I think it would be especially useful to him later when he is evaluating the progress he's made. And I told Decker that I respected him for realizing that he needed help and taking the steps that he has to get it. It must not have been easy for him. In fact, I can't think of another schizophrenic I've treated who wasn't brought in by someone else. They usually don't come in by themselves. But Decker doesn't believe he deserves the credit. He gives it instead to Simian, who he says urged him to get help from me. I told Decker that we would work together on his goals, which are to move out of his mother's house, have a real friend--someone he can invite to a baseball game and, I presume, having an intimate relationship with a woman who doesn't savage him.

Thursday, May 8, 1997
I got a message from the service. Decker Jenkins moved his session to Friday. He said that something really big had come up and he needed to stay quick on his feet. I tried to call him back, but there was no answer at Karen's. I didn't feel comfortable leaving a message there, so I just hung up. I assume he'll come at his normal 10 am appointment time.

Thursday, May 15, 1997
11 am. Telephone Conversation with Decker Jenkins. Decker called me from jail. Apparently, Karen has been murdered and Decker thinks he might have committed the crime. But Decker isn't certain. He has a memory lapse respecting the critical time period. Decker might blame the drugs for the memory lapse and for his actions, but we couldn't really get into it because he was calling me from a prison phone which he only had access to for ten minutes or so. I told Decker not to make statements to the police without his lawyer there. After Decker got off the phone, I called the Hall of Justice and found out that I had to speak to the health officer--a guy named Vincent Andrews. I spoke with him, and he was surprisingly helpful and reasonable. I'm afraid that my preconceptions are based in part on media mythology. Anyway, he's going to make sure that Decker gets his medication and is going to put Decker on a suicide watch. He also gave me the number of the San Francisco public defender's office, which I called. Unfortunately, I could only get a machine.

Monday, June 9, 1997
11 am. Telephone Conversation with Decker Jenkins. Decker is out of jail and has been roaming the streets for the last couple of weeks. He has been in and out of homeless shelters, but finally he has surfaced. He went to his friend, Mr. Knopff, who has allowed Decker to live with him and has given him his job back on condition that he continue his sessions. Decker has kept taking his medication, and it's doing him a world of good. He seemed relaxed and quite normal in his conversations. He was focused and able to converse freely. He is clearly more organized in his thinking. He also seemed excited about continuing his therapy. He said that Simian hardly bothers him anymore and he acted as though Karen's murder relieved a burden rather than a tragedy--for Decker, it might have. Decker rescheduled an appointment for Thursday this week and he promised to tell me then how he was cleared of Karen's murder. I was surprised that I hadn't been contacted by the police, but then again, maybe I shouldn't be surprised. Perhaps they're just too busy to talk to their suspects' psychiatrists.

Thursday, June 12, 1997
10 am. Fourth Session with Decker Jenkins. Decker is completely altered since the last time I saw him. He is calm, focused, and much more relaxed. He is able to look me directly in the eye. He says that Simian has almost completely disappeared, except for one short time each day when his auditory commentary becomes evident. Decker shaved his head, but he has a good looking skull. Somehow, it makes him look less menacing, which is surprising because I would have expected that it would have the opposite effect. When he speaks, he still moves his hands very little, although there was some slight hand movements during part of his story. And it was quite a story. He told about how he fought with Karen the night of her murder and he may have struck her. He says that he has blanked the episode out of his memory. But when the police wanted to talk to him, he assumed that they must have thought that he did it, so he confessed to the crime. While he was in prison, he had an opportunity to get this thoughts together and decided that he couldn't have done the murder--it wasn't in his nature. After a couple of days in prison, the police told him the horrific circumstances surrounding Karen's murder. While Decker was describing how she was brutally raped and had her skull crushed with a blunt object, he displayed absolutely no emotion or sadness, although he gave some lip service to feeling sorry that she felt pain. Apparently, though, the semen sample they recovered from the body eliminated Decker as a suspect. And he was released. Although he wasn't the rapist, I wonder if he had more to do with her murder than he has told me. It seems an odd coincidence that, on the night of her murder, Decker has this violent confrontation with Karen which is traumatic enough to induce partial amnesia. In any case, Decker is very pleased with the changes which the anti-psychotic drugs have made in him, and he swears that he will continue to take the medication.

Thursday, June 26, 1997
10 am. Fifth Session with Decker Jenkins. Decker has gotten over his cold and is sleeping better now. He said that he is resigned to taking his medication for life, but he complained that he didn't feel like he had a "clear mind" on it. But he was really uncommunicative during this session--he is back to no eye contact whatsoever. Although he was clearly disturbed about something, he wanted to stop early. When I called him on it and wanted to keep our session going, he exploded. He stormed out of the office, but not after screaming obscenities at me and saying something interesting. He asked me if I was afraid that he would lose his mind and "bash your head in, too?" I found the "too" particularly unsettling. Does he think of himself as a murderer based upon the different way that people treat him, now that he has been accused and then cleared of it? Or did Decker have some involvement in the murder of his mother that I'm not aware of yet? I should speak find out what medications Decker was taking for his cold and consult with a pharmacologist. Based on his fairly irrational behavior, it seemed to me that he might be suffering from a drug interaction between the risperidone and some cold preparation. If that's true, he should be better by the next session.

Thursday, October 2, 1997
10 am. Telephone Call with Decker Jenkins. I was surprised by the phone call I got from Decker. The last time I saw him was during our fifth session together on June 26th of this year. He was very irrational then--I even suspected an interaction between his cold medicine and the risperidone that I gave him to control the symptoms of his schizophrenia. I remember that I was very bothered then by some of his comments about the murder of his mother. He gave me an impression that while he had been cleared of her murder, Decker might still had more to do with that event than anybody knew. Now, he tells me that he was in Chicago and has found his long lost father. Decker said that seeing his father made him understand that he needs help and that he wants my help. I was glad that he was interested in starting up our sessions together, but I wanted to probe just how serious Decker was about therapy. It seems that he is, and we have set up an appointment for next Tuesday at 11 am. An interesting note, not once during this conversation did Decker mention Simian--the imaginary and very distractive voice inside his head. But Decker seemed very edgy and scared, much like he was before the ameliorative effects of the drug therapies began. My guess is that he has stopped taking his medication, which must mean that Simian will have returned in full force.

Tuesday, October 7, 1997
11 am. Sixth Session with Decker Jenkins. Decker came in transformed from the way I last saw him. He was well-dressed and groomed--he still shaves his head but it seems to enhance his appearance. He seemed cool and confident--a long way from the very nervous and introverted man I last saw. He was joking and smiling a lot. He was obviously very relaxed and made direct eye contact throughout the session. To be honest, he made me feel a bit uncomfortable, but I'm not sure why; perhaps it is because I still think it probable that he bears some responsibility for his mother's death. All of the above notwithstanding, Decker appeared a bit tired, which may just be a consequence of his recent traveling. Decker stopped taking his medication, as I suspected, and Simian has returned. However, to hear Decker explain it, Simian seems to have gone through a major personality change. Now Simian is no longer a force for evil, but rather a somewhat considerate old man who happens to live in Decker's head. Decker now realizes that on some level Simian is just a reflection of himself. He says that Simian will allow him to make his own decisions, although he feels free to comment on them when he disagrees. Decker is resistant to taking medications and says that he doesn't think it necessary--that Simian is under control. I told Decker that I wouldn't force him to take the medications, but we agreed that if things degenerated from Decker and Simian's present state of calm truce, Decker would start somatic treatment. At the beginning of the session, Decker made an elaborate show of thanking me for being his friend. But his thanks degenerated into a display of some slight hostility for what he feels is a one-sided friendship--i.e. he considers me a friend but I'm in it strictly for the money. Decker told me that when he was going through his mother's possessions, he found a bank statement in his name. On researching further, he discovered that a savings bond worth about $250,000 was on deposit for him in a bank in Chicago. He went to Chicago and got a cashier's check. It turned out that the money had been deposited when he was born by his father, a man named Anthony Parish. Karen had always said that she didn't know who his father was, so Decker was surprised to find that he even had a known father, not to mention one who had settled such a large sum of money upon him. Apparently, Decker contacted him and they spent some time together in Chicago, although we didn't get that far in the story. Decker made an appointment for next week.

Tuesday, October 7, 1997
Some Poems & Doodles by Decker Jenkins. Decker gave me two of his poems to read together with some doodles. The first poem seems to be about self-mutilation from a character who might be Simian--a dying old man. The old man finds pleasure in the pain that he inflicts--pain perhaps meant for Decker, whose is just another aspect of himself. The second poem seems characteristic of a sufferer of early childhood abuse. The poem talks about victims and pain and the need to hide the pain and keep a solemn face turned towards the world. It also seems that there is a revenge element to the poem--the victims waiting to return the favor of the pain back on the abusers. There is a prayer for godly justice, which might reference Karen's death--"Those who live by the sword, die by the sword."

Tuesday, October 14, 1997
11 am. Seventh Session with Decker Jenkins. I was unavoidably 20 minutes late to the session today, and Decker was furious. His anger was out of all proportion--almost as if he was in a murderous rage. Decker clearly views the world through a distorted prism caused by schizophrenia and paranoia, so at the end of the session, I invoked our agreement and renewed his prescription to risperidone, 6 mg. daily + Vitamin E, 1200 IU. When I asked Decker about the rage that he exhibited, he bristled at the term and preferred to call it "fury." He thinks the term "rage" has an evil connotation connected with death that "fury" does not. Fury is just pure anger. Decker told me the story of meeting his father--Mr. Parish--for the first time. It took him over a month of waiting, while he lived with Pam--a woman with red-orange hair and bright red lipstick--that he met by chance there in Chicago. He met her when she came to his assistance after he swooned against the side of an office building--he promises to shock me with the story of Pam next week. Apparently, merely by thinking about the vagaries of his own identity, he hyperventilated and almost passed out. After about a month, his father finally called and they met in a restaurant. Decker said that he and his father look a lot alike. They spoke about Decker's early years--Decker promised that the details will come later. It's interesting that Decker kept referring to his father as "Dad" although it was clear that he doesn't think of him that way.

Tuesday, October 14, 1997
Another Poem by Decker Jenkins. Decker gave me another poem, and I encouraged him to write more as a way of expressing his feelings and emotions. Decker's current poem is another dark entry, with hints of violent suicidal ideation and a desire for assistance.

Thursday, October 30, 1997
10 am. Eighth Session with Decker Jenkins. Decker began talking about his father's visit to San Francisco and the revelations it brought about Decker's childhood. Karen was a hippie in 1968 and she ingested a number of drugs, including LSD and marijuana, which was her drug of choice. She met and got pregnant by Anthony Parish, Decker's father, and they got married. Throughout the pregnancy, however, Karen continued to smoke marijuana against Anthony's wishes. After Decker was born, Karen ignored the baby and, according to Anthony, he had to take charge. But when Karen refused to give up drugs, Anthony left and tried to take Decker with him. When Karen threatened him and the baby with violence, Decker's father just left, never to be heard from until now. That story doesn't ring true to me. If Decker's father was so concerned about the well-being of an infant with an unfeeling and irresponsible mother, he would never have abandoned the infant, at least not in an attempt to get Karen to change her drug-using behavior. But I'm certain that Anthony is motivated by rationalizing his own guilt. Decker told me the promised shocking story about Pam--the woman with red-orange hair and bright red lipstick with whom he lived in Chicago. Decker said that some time after they met, he was sleeping on her couch and she came and began to sexually stimulate him while he slept. Decker feigned sleep up to and including the point where she mounted him and performed intercourse. Decker continued to pretend to be asleep even during his orgasm mostly because he didn't know what else to do. So that was how Decker lost his virginity. After that, the ice was quickly broken between them and they engaged in frequent, unprotected sexual activity during the rest of the time, which I gather was at least several weeks. When Decker told Pam that he was planning on going back to San Francisco, she "freaked out" and said that she had been used by Decker. She even said that Decker had raped her--a charge that Decker emphatically denies. Decker doesn't know if she followed through with her threat by contacting the police, but thinks that it is possible that there is a warrant outstanding for his arrest in Chicago. Based upon what Decker has told me, a charge of rape seems difficult to sustain. Pam would have no injuries and there would be no evidence of force. And there must be many witnesses to Pam's and Decker's happy cohabitation both before and after the alleged event. However, a charge such as rape is obviously extremely serious. I told Decker that we should wait to see what might develop, but I am a bit uneasy, especially because I've never satisfied myself as to the actual facts surrounding Karen's death. I honestly don't know if Decker is incapable of committing a violent assault such as rape. To make matters worse, Decker told me that he met a girl back in the bar who turned out to be none other than Christina Herald--the double bock drinker. They made an innocent social date, but Decker is alternating between not showing up and fantasizing a long future with Christina. I can't warn Christina without breaking doctor/patient privilege, but frankly I won't be overjoyed if they decide to begin a relationship together.

Thursday, October 30, 1997
5 pm. Twenty-Second Session with Christina Herald respecting Decker Jenkins. Christina was more upbeat and genuinely cheerful this session than I've seen her in a long time, and it was infectious. She is clearly looking forward to her date with Decker, and I had no way of letting her know that he was under my care and that she should be cautious. I think it will probably be fairly uneventful, actually. They're just meeting at a museum to look at baseball artifacts--and Chris is fairly savvy. She even questioned whether he might be a neo-nazi after a look at his shaved head. She can take care of herself.

Thursday, November 6, 1997
10 am. Ninth Session with Decker Jenkins. Decker was in a very weird mood throughout the entire session. He kept saying that he felt normal--stressed it really. He has moved into a new place. One of his neighbors dropped by, and he smoked a joint with Decker. Decker sees it as part of his new freedom--an opportunity to experiment with all the things that were forbidden by Karen. I am very concerned, however, about Decker becoming involved with these types of substances. I think that the abuse of recreational drugs by psychotics is an extremely bad idea. Decker seemed to come all unglued when I chided him on this, and ended the session early.

Thursday, November 13, 1997
10 am. Tenth Session with Decker Jenkins. Decker came into the session sick because he drank tequila to excess the previous evening. I lectured him in the sternest, most paternalistic of manner, that he can not mix his medication together with alcohol. He waved me off, assuring me in a breezy way that he would behave himself in the future. He was annoyed with my warnings, rather than angered by them. He feels comfortable with his new friend Telso, and they went out drinking together. Decker also told me about his date with Christina. He said that he believes that she really likes him--and he affirmed that he really likes her. The way he describes the date, he comes off as impossibly shy, but she apparently used her ignorance of baseball as a lure to draw him out. He plans to ask her out again. I'll find out from Christina how she viewed the date. Perhaps she was not as enamored of him as he was of her. Decker looked quite tired, with large rings under his eyes. I told Decker that I wanted to explore his childhood years with Karen. Decker jauntily answered, "Fine." I half expected him to protest against that change of subject, but the prospect of discussing Karen with me didn't seem to faze Decker.

Thursday, November 13, 1997
5 pm. Twenty-Third Session with Christina Herald related to Decker Jenkins. I'm not certain that I'm doing Christina any real good. [...] The one area that I might have actually been of some use to Chris--warning her away from her budding romance with Decker--is ethically foreclosed to me. And yet I'm very concerned about his possible violent tendencies. But I have nothing concrete at all, just the circumstances of his mother's death--he was cleared by the police--and his statement that there is a woman in Chicago who may have wrongfully accused him of rape. Perhaps I should spend some time with Decker exploring whether he has any violent ideation. Chris, in the meantime, positively gushed over her date with Decker. I think that if I did have actual knowledge that Decker was a danger to Chris, I would warn her--ethics be damned!

Thursday, December 4, 1997
10 am. Eleventh Session with Decker Jenkins. Decker told me a horrible story about his mother's boyfriend finding her in bed with another man and blowing that man's head off. Decker described coming upon the scene and seeing the decapitated body of the man with his naked mother covered in blood and brains. While Decker related it as a true story, this is just the type of violent misogynistic fantasy which Decker is prone too. I don't know how much credit, if any, I should give to the story. Decker said that the murderer in the story was one of the few men that actually stayed for a week. He said that Karen was trying to pretend that they had a relatively normal family life--family dinners, going to movies, and the like. Decker said that this incident occurred just prior to Simian's arrival on the scene. Decker also told me that his mother's usual pattern was one night stands--she would frequently bring home men, feed them dinner and then engage in sex with them, taking few pains to hide her activities from young Decker. He even said that she would ask them to beat Decker for her--"he needs a man's influence"--and reward them with an act of fellatio. Again, it may or may not actually be true. Decker said that he spent a great deal of money to bail his friend Telso out of jail. Telso was arrested on a possession of cocaine charge, and it was not his first arrest. Since Decker made bail, he hasn't seen Telso--not a good sign. Decker also told me that he showed up last Thursday for his session, on Thanksgiving. He said he went through the motions of his day, never realizing it was a holiday until he discovered that I wasn't in my office. Then he noticed that everything else was closed too. But Decker reacted with humor--quite different from the time that he was livid with anger when I was a few minutes late at the start of a session.

Wednesday, December 10, 1997
3 pm. Telephone Conversation with Decker Jenkins. Decker called me to tell me that his father died in an automobile accident this morning in Chicago. He is flying back to take over the arrangements. Decker said that he was glad that he hadn't gotten to know his father well and asked me if I understood what he meant. I did, of course. Decker sounded sad, but matter-of-fact--maybe even a little excited.


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