Monday, January 20, 1997
4 pm. First Session with George Landau. I had my first session with George Landau, a new patient today. He seemed almost an anachronism. He is a tall and thin 52 year old man who dresses in elegant manner, with an old fashioned flair. He had on a pinstriped suit, gray waistcoat, and a pocket watch and fob. His black shoes were highly polished. His tie was straight and his hair was neat. George is obviously someone who takes some care in his appearance, although the overall effect is somewhat odd for the employee of a high tech company. He actually reminded me most of an old-fashioned English banker. Although George was not wearing a hat, I felt sure that he owns one. George was quite tense during our session. When he finally was persuaded to take a seat, he sat perched on the edge as though afraid that relaxing into the chair would lure him into making a slip and revealing too much. He was also aggravated during our session. Apparently, his superior is a much younger man--Simon W. Taylor--who has demanded that George seek my help. I'm not sure what for, although George believes that Mr. Taylor thinks him lazy. Aside from George's suspicions that I was trying to wrest his secrets from him, he didn't evidence any obvious signs of mental illness. I do get the impression that Mr. Landau may be a bit of a fussbudget, but that might be a professional asset in the position of a Senior Administrator. George has two children: Daniel, age 11 and Elizabeth, age 13. His wife's name is Melissa. He doesn't report any particular conflict with any of them except for normal teenage friction with his daughter, but he was exceptionally guarded in this session. He didn't report any physical ailments or symptoms. He said that he would return next week, although I guess that he'll do what he can to get out of it.

Monday, January 27, 1997
4 pm. Second Session with George Landau. Although George continues to fight me, I felt that we made a little headway during this session. His resentment of Simon Taylor is strong, but not irrational. For example, while he passionately criticized Mr. Taylor's implementation of a rigid form system for procurements within the company, he was not over broad in his condemnation--he was willing to admit that it had certain advantages even while he called the dehumanization that it represents "the disease of our time." George was considerably less agitated this session from the last. He also was wearing a brace on his right wrist. He wears the brace periodically for a repetitive strain injury which causes him frequent, although intermittent, discomfort. When I tried to talk about his injury, George became suspicious of my motives, fearing that I was "grasping at straws" to come up with something that was wrong with him. I think he was concerned that I was going to ascribe a psychological origin to his injury. George saw my Powerbook Computer and became quite upset with the idea that notes about him were contained inside. I explained about the password protection and that it wasn't networked together, and then he surprised me by questioning me closely about the power cord. He seemed to indicate that someone might be able to get in through that cord. Either he is remarkably unsophisticated about such matters given that he works at a high tech company, or he knows something that I've never even guessed at. It's too paranoid, isn't it? The power grid is a network of sorts and the electrical impulses that make up the contents of computer memory could cause some form of voltage oscillations or variations which might be read through that network. It sounds impossible, but it's an intriguing possibility. Unfortunately, the truth is that none of my notes on George have been insightful enough yet to warrant such snooping. I hope that I can pierce his very proper facade to get to some of the issues that are really bothering him.

Monday, February 3, 1997
10 am. Telephone Conversation with George Landau. I had a brief conversation with George. George is ill with recurrent nausea so he canceled our session and missed work today. George said that Taylor will react badly to his absence even though George was scheduled for some training course rather than performing his normal duties. We rescheduled our appointment for this Thursday.

Thursday, February 6, 1997
2 pm. Third Session with George Landau. I'm finally making some headway into George's icy reserve. He's slowly getting a bit more comfortable during our sessions. Well not comfortable actually, but at least not actively hostile. George has personified his boss as all that is impersonal in society--valuing technology for its own sake, despite its dehumanizing effect. George sees himself as the last of the old guard, who sought the human touch even while denying someone's request. Mr. Taylor sees fairness in a mathematical division of resources, while George believes that a human can better divide resources according to a perception of need. George sees value in the exchange itself, while Mr. Taylor only desires an efficient allocation. This is the backdrop to George's fears that he is about to be ousted by Taylor. He sees the choice offered by Taylor--go into therapy or be fired--as a Hobson's choice, because he feels that Taylor is going to use the fact that George is in therapy as a lever against him. I tried to point out that this would have been a bad move by Taylor--you can't fire someone because they are sick. But George doesn't see himself as sick and, frankly, neither do I. Perhaps George is a bit tense and he feels a bit persecuted, but I'm not sure I am accomplishing any medical purpose in our sessions. In reviewing the DSM classification for Generalized Anxiety Disorder, I don't think George is a particularly good fit. I can serve as a counselor, and I think that has some value in George's case. I was also considering giving George a mild sedative, because he seems to have the ability to work himself up into a frenzy over the seemingly trivial. I was thinking that perhaps a tranquilizer would enable him to take a more dispassionate, objective view. I was considering a very mild dose of one of the benzodiazepines. But in reflection, I don't really think George is a very good candidate for these sedative-hypnotic agents. And I certainly don't want to give Mr. Taylor some cause to fire George, if George's suspicions are indeed correct. George is a bit of what used to be called a "Fuddy Duddy," but I like him and I feel protective towards him and his job. Even if he is a bit of a throwback to another era, I get the sense that SII is all the more human because of his efforts there.

Tuesday, February 18, 1997
2 pm. Fourth Session with George Landau. George came in slowly and sat down heavily in the chair, as if the cares of the world were pressing him down. He sat there, with his arms folded in front of him, daring me to try to wrest his secrets from him. He didn't wear his wrist brace to this session. George declined my invitation to discuss Mr. Taylor, so I decided to ask about George's wrist. He calls his carpal tunnel syndrome an irritation rather than a major annoyance and believes that it came from computer use. The diagnosis of CTS came from his own practitioner, a Dr. Harris. George was careful to tell me that he'd moved his practice, as if worried that I'd check up on his wrist. He seemed unsure about whether nerve conduction tests had been performed, although he then claimed vehemently that they had. Actually, George strikes me as an atypical CTS sufferer. I will request George's medical records be sent to me from SII. George's previous boss, Tom Windsor, gave George more latitude on account of his disability, switching his duties away from office work and towards the kind of social interaction which George prefers in any case. Simon Taylor apparently does not permit George the same flexibility. George was aggravated by my suggestion that he increase his technological skill base, and became more and more actively hostile towards the end of the session until I felt that there was no constructive reason to continue.

Friday, February 21, 1997
1:22 pm. Telephone Conversation with Mr. Simon Taylor Respecting George Landau. Simon Taylor called me unexpectedly today. I'm familiar with my patients exaggerating the negative characteristics of their bosses, so I'm not sure exactly what I expected from Mr. Taylor. I at least expected him to be all business--brusque and autocratic or something. I was somewhat surprised to find that he seemed warm, reasonable, and sympathetic. I got the strong sense that he was genuinely concerned about George's well being. He was trying to tell me something...he seemed surprised that I hadn't divined it already. He said something about how George is always trying to hide it. But he thought better about it, apparently thinking it wouldn't be fair to George to interfere in our Doctor/Patient relationship, so he abruptly ended the call.

Monday, February 24, 1997
2 pm. Fifth Session with George Landau. George was subdued during this session. He was wearing his wrist brace and seemed clearly tired, almost haggard. Naturally enough, our conversation turned to his difficulties sleeping. He reports that he is having a series of nightmares which, in turn, cause night anxiety. I asked him to describe one, and he told of a nightmare about powerlessness and about primal fears of the anticipation of imminent pain and death. It was a horrible nightmare about being locked in a room and hearing someone in the next room being hideously tortured, knowing that next it would be your turn. The torturer in George's dream is an "it," not human but otherwise unknown. George is able to wake himself when the "it" arrives in his room, but apparently not before. George might be a good candidate for some lucid dreaming therapy--we'll have to consider that in future sessions. And while hypnosis might be beneficial, I have a sense that George would never permit himself to lose control to that degree. George is all about control--his greatest fears seem to revolve around losing it. George also has a unique concept of evil as a palpable entity--a smothering black force which seems to lurk in particular objects. He describes his mounting terror over the evil emanating from an overhead projector during a presentation at SII. George believes that if one does not see the evil force than one is probably not in danger. George realizes that his notion of evil is not the social norm and was embarrassed to have revealed so much to me. He insisted on changing the subject. Apparently George is actually having some perceptual delusions--he thinks that he sees evil as a physical phenomenon. This makes his treatment a greater imperative than I believed before. But George rejects somatic treatments, disdaining the idea of any drug therapies. I think that also stems from his desire not to lose control. Since lucid dreaming is all about gaining control, perhaps this would be an acceptable way for George to be able to face his terrors.

Monday, March 3, 1997
10:13 am. Telephone Conversation with George Landau. George is sick with nausea again and can't make our session today. Apparently, he is suffering from some unidentified gastrointestinal distress. He wished to just skip this week's session, so we scheduled an appointment for next week.

Wednesday, March 5, 1997
10:45 am. A couple of memos regarding George Landau arrived. I had requested George's personnel record, especially anything involving illness or his carpal tunnel syndrome. I got only these two relatively recent memos--one from Simon Taylor to his boss Malcolm Spunt, and then the reply. Taylor noticed that George is always sick on the first day of each month and he conjectures that George is trying to avoid a training session on some computer software program which is scheduled at that same time. The pattern that Taylor noticed in his memo of January 6th held on February 3rd and again on March 3rd. Both of those days were the first Monday of the month and on both of those days George cancelled his sessions with me because of illness. George sounded genuinely sick when I spoke with him on March 3. Either he was dissembling or his unconscious has taken over to protect him from the training exercise which he clearly either consciously or unconsciously is trying to avoid. Obviously, this is a significant area which bears further exploration. I was also struck in the letter from Taylor to Spunt with the apparent degree of concern and regard shown to George. This is consistent with my conversation with Taylor on February 21 but is wholly inconsistent with the picture that George has painted of Simon Taylor.

Monday, March 10, 1997
2 pm. Sixth Session with George Landau. I decided to force the issue and not allow George to continue telling me everything was all right and that he was perfectly fine. So I told him that I would excuse him, with a clean bill of health, from coming to further sessions. When George thought I was abandoning him, he opened up and admitted that he was terrified. Of what, I'm not certain. But at least we made some progress breaking through the hard shell of reserve in which he resides. George broke down and wept. Then we were able to proceed with a great deal more honesty. Since the department switched over to a new computer system, George has successfully avoided the training courses through recurrent bouts of stomach cramps and nausea. George insists that the symptoms he feels on the first Monday of each month are very real. But after he's sure of missing the training, his condition improves. He does become anxious the day before the training sessions are to begin, so there could be a physical component caused by stress, but George's malady seems likely to be primarily psychosomatic in origin. That doesn't make it any less real for George, of course. George manages three staff members and feels that he is accomplished at avoiding dealing with the computerized system. He has his subordinates retrieve the information he needs from the computer. To them, he consciously hides behind his "fuddy-duddy" image. But that's not working with Simon Taylor. During this session, George did not wear his wrist brace.

Monday, March 17, 1997
9:25 am. Telephone Call from Melissa Landau re: George Landau. Melissa called in to cancel George's session for today. She sounded very pleasant with a melodious voice. She said that George has a fever and is in bed, and told me that George wanted me to know that he was "just plain sick this time." Since it's not the first Monday of the month, perhaps he really is sick. Melissa said that she was surprised George hadn't been difficult during our sessions, describing him with affection as a "stubborn old horse."

Monday, March 24, 1997
2 pm. Seventh Session with George Landau. I hadn't realized until this session the extent of George's phobia--a full fledged phobia of technology, particularly machines or devices which utilize electricity. He has no idea how to use a computer and, more than that, he is terrified of the box itself. His fear is not merely that he will reveal himself as technological illiterate, although he recognizes that to be true as well, but rather that the computer itself is somehow evil and sentient. I haven't noticed any particular ritualistic patterns, so I don't think that we're looking at obsessive compulsive disorder. I've had some success using flooding techniques in the past. George will initially hate me, of course, but I think that repeated exposure to the hated stimulus in a controlled setting might lessen the anxiety associated with the computer in his office and for his training program. Or we might try the guided visualization techniques of systematic desensitization. I must remember to ask George about the actual feelings that he experiences when he is in contact with a trigger. Does he have full-blown panic symptoms, or is it just a sense of unease and an inability to concentrate?

Wednesday, April 2, 1997
2 pm. Eighth Session with George Landau. George has felt a rush of empowerment by admitting his phobia of computers. He feels strong enough to go and tackle a training session without the benefit of any type of previsualization. I wanted to guide George through what he might expect--an attempt at desensitization. But George was immediately resistant. Now that he has a bit of courage, he wants to jump into the situation without thinking about it in advance--like jumping into cold water. I'm afraid it's a terrible idea, but the more I tried to talk George out of it, the more he accused me of trying to undermine him. He agreed to give me a call on Monday after the training session. I hope that it doesn't go as badly as I fear.

Monday, April 7, 1997
9:55 am. Telephone Call from George Landau. Today was the day when George was going to exercise his newfound courage and face the training session without further preparation. Of course, it ended poorly, with George, on the way to the course, ordering the taxi to stop and then throwing up on a sidewalk. George acknowledges the need for therapy and desires to continue, although he asked for a hiatus until April 21. We have a lot of work to do before his next training session, if he is going to be able to make it then.

Monday, April 21, 1997
2 pm. Ninth Session with George Landau. George had a breakthrough of sorts. After his experience throwing up on the sidewalk before his training class last Monday, George took things into his own hands. He explained the situation to his supervisor, who took it very well, actually. George spent a number of his early sessions vilifying Simon Taylor. I remember being surprised when Mr. Taylor called me and sounded genuinely concerned about George. The spectre of Mr. Taylor was obviously primarily a projection of George's anxieties and had little to do with the actual man. And George gave a lot of thought to his malady over the last couple of weeks. He was even able to come to the conclusion that his carpal tunnel syndrome was a sham. He never actually had a doctor diagnose it--instead, he had read about the syndrome, had a friend in a hospital who got him a wrist brace, and used it to treat pain which he actually imagined that he felt. I'm certain that the pain he felt in his wrist was quite real, even though at one level he knew that he was deluding himself. I talked to George about flooding as a technique to confront his fears and he seems ready to try it.

Monday, May 5, 1997
2 pm. Tenth Session with George Landau. One of his wife's friends has cancer, and that's causing sleepless nights for his wife. George is also experiencing sleeping difficulties, with a recurrence of his nightmares. So, as a couple, George and his wife are getting very little sleep. But George's relationship with Melissa is close enough to weather the rough spots. And the understanding showed by Simon Taylor at work is allowing George a bit of a breather there as well. I began our work today with an extensive discussion of just where the trigger for George's fear of machines lies. George recalled the spook train rides in an amusement park. He describes the sensation of being swallowed whole by some diabolical machine--able to work its will while the rider is hurtled about in the dark. George was groping for some proper expression of his feelings about machines. He talked about machines as being sentient and malevolent, not because he believes intellectually that it's true, but rather because it is how he feels about them. He described his actual sensations when confronting the machine as a wave of fear. He says that he can't breathe or move. More than just feeling threatened, he feels exposed to the machine, as if it can read his every pore and thought. George has become very open with me, not afraid to articulate his feelings even when he realizes that they make him sound foolish. I think he's ready to actually confront the object of his fear under controlled and non-threatening conditions, which we'll start when next we meet in two weeks.

Monday, May 19, 1997
2 pm. Eleventh Session with George Landau. Although George tried to stall a bit, we started doing guided imagery as part of George's flooding therapy. I got George through a cab ride, up an elevator, down a corridor, and almost into his training program's room before he put a stop to it. He seemed distinctly uncomfortable during the flooding, which means that George has a good imagination and we have a greater chance of success with the guided imagery approach. We just have to take it very slowly. George hates the feeling of being out of control, which may prove a key to giving him more assurance in dealing with machines.

Monday, June 2, 1997
2 pm. Twelfth Session with George Landau. The flooding continues. George was not really in the right frame of mind for today's session, and if he was coming once a week, I probably would have passed on the session. But since I see him only twice a month, I thought it important that we continue. We used directed visualization to get George into the room where the computer classes are being held, and after a battle with a coffee machine, George broke the session by breaking out of the scene that we'd established. I tried to put him into another scene--this one at his office where it was imperative he turn on his computer to get some figure--and again he broke out of the scene when it became uncomfortable. I let him leave it like that, and although I urged him to come in next week, he refused. I hope that during our next session, George is better prepared to continue the flooding approach.

Monday, June 16, 1997
1:30 pm. I got a telephone call from George Landau. He has decided to take a break from our therapy sessions. Apparently, I pushed too hard on the flooding strategy. It's unfortunate, because I felt that we were making some real progress and a break right now will jeopardize all of our efforts. But George sounded very determined on the phone. I'm hoping it is a temporary reaction to the session two weeks ago, but I'm afraid that I know better.


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