Tuesday, June 24, 1997
10 am. First Session with Kester Langford. I met Kester for the first time today. He presented a fairly ordinary appearance--medium build, a day-old beard, black pants, a white shirt buttoned all the way to the top, and no jewelry of any kind--not even a watch. He was wearing black sandals with black socks. Kester's complaint is somewhat unusual. He reports an obsession with making marks--something that he's done since he was about eleven years old. The marks are usually made with some form of paint or ink on some medium--I don't think he is a graffiti artist. Kester's compulsion to make these marks keeps him from holding down any other kind of job. Although he's had several, he loses his focus when he has not been able to make marks for a number of hours. Kester is fifty years old, and he is clearly worried that he is unable to earn a livelihood that would keep him sheltered and fed. Kester doesn't consider himself an artist, although he said that many of his friends do. I didn't get the sense that he demurred out of modesty--he sees himself as a mark maker, not an artist, and he makes his marks because he is compelled to do it. I asked him to bring some of his marks to the next session. There's a certain intensity and desperation in the way that Kester spoke, although his interpersonal skills were generally good. He had a firm handshake, and he looked me directly in the eye. He expressed himself clearly and with plenty of affect. At the end of the session, I became worried that he might be suicidal--he seemed to be quite desperate to solve his problems immediately. He indicated that he had considered it, but had no current plan to commit suicide. He needs to be carefully monitored during future sessions. My guess is that Kester is suffering from obsessive compulsive disorder and, perhaps, depression.

Tuesday, July 8, 1997
1 pm. Second Session with Kester Langford. Kester and I spent this session talking about the nature of art, the nature of the therapeutic process, and the difficulty of making a living as an artist. He read me one of his poems and showed me one of his paintings--quite nice actually--to me, his marks look reminiscent of Chinese calligraphy. But I get the sense that we are skirting all the issues that are really important to Kester. He seems deeply troubled, and I don't think it is by the difficulty of earning a living as an artist, which is what he'd have me believe. So we skirted around all the important points in his life, with him either fearfully probing me or dishing out elaborate compliments--but never zeroing in on himself. Since Kester is so obviously uncomfortable, I felt that it was better this session to allow him to set the pace--and we danced lightly on subjects as if we were conversing at a cocktail party. But I think I owe it to him to insist on a deeper level of interaction in future sessions. Kester puts himself down quite frequently--he seems to devalue the work that he does until it comes time to sell it, and then he sets wildly extravagant prices which presumably means that the work doesn't sell. My impression was that he almost can't bear to part with any of his work. He mentioned that his work is being held for him by a number of friends--they even hang it on their walls while they wait for him to pick them up. He certainly feels personally invested in each one of the pieces. They represent aspects of himself in some fundamental way. It seems as if he feels that he would be losing that part of himself if he sold or gave any of them away. He read me a poem that he wrote 26 years ago. While my poetry appreciation skills are admittedly somewhat non-existent, his explanation of the poem was certainly more revealing than the poem itself. The poem was almost an apologia to living a life dictated by passion rather than monetary considerations. Kester believes that he has been blessed with clarity of vision which allows him to escape mundane limitations through the attainment of wisdom.

Tuesday, July 22, 1997
1 pm. Third Session with Kester Langford. Kester appeared quite agitated at the beginning of our session. When I probed, he told me that he had been evicted from his room and was preparing to move back to the streets unless he found another room somewhere. But even with that unhappy prospect looming over him, Kester seemed unable to muster sufficient energy to even post notices at coffeehouses seeking living accommodations as is his normal practice. Although I haven't decided that medication is definitely the best route, I asked Kester if he would be amenable to medication to treat his depression. After some initial hesitation, Kester seemed to warm to the idea. I'm afraid that Kester is looking for the medication to serve as a magic solution to all of his problems. We talked a bit about Kester's family. His parents both died in the early 1990s, leaving Kester only with an older brother with whom he hasn't spoken in ten years. At the end of the session, Kester indicated that he had an embarrassing sexual problem that he wanted to discuss. But he was so shy about bringing up the issue that I pushed it over into our next session.

Tuesday, July 29, 1997
1 pm. Fourth Session with Kester Langford. Kester began the session by confessing that he had felt a great deal of anger and hostility towards me over my refusal to display his marks on my office wall. As we talked about it, it became clear that Kester's anger really originated elsewhere, although I provided a focus. He talked about his family and revealed that they had introduced a great deal of insecurity into his life through their tendency to frequently change their minds about their jobs and living arrangements. Because he moved several times a year as a child, he never knew whether he was going to be able to keep any of his friends. Finally, Kester almost thanked me for being unyielding in my decision not to display his marks. He seemed to appreciate the limits that my decision set on our relationship. Kester said that he believed that most of his pain and anger were self-motivated, but it almost seemed like pop psychology talking rather than any deeply felt conviction on his part. Kester didn't want me to think that he blamed another for his problems, although he probably has a host of resentments towards specific individuals in his life. However, Kester said something that I thought was quite interesting. He said that he was afraid that if he wasn't angry, he would forget the people who were most important in his life--as if they are constructed in his memory out of a series of painful episodes. When I pressed him on it, he told me that when his parents passed away, he lost a certain ability to function. It was as if their enthusiasm and support for his ideas and projects were an essential emotional safety net in his life. Kester answered an ad and got a job of sorts providing security for an art gallery in exchange for a studio apartment above the gallery. Apparently, he can only live there six nights a week and must vacate the unit on the seventh night of each week. Kester is hopeful, of course, that the gallery will ultimately display his marks, but he is savvy enough to realize that he should take it one step at a time. I asked Kester to take a blood and urine test and he seemed quite willing to comply. Specifically, I'm interested in making sure that his thyroid and kidneys are operating properly prior to considering a somatic treatment for bipolar disease. Specifically, I ordered a urinalysis, serum electrolytes, BUN, serum creatinine, and serum T3 and T4, together with a routine drug screen on the urine. I also asked the lab to run a ECG to give us a baseline against nonspecific changes frequently caused by lithium carbonate that don't reflect cardiotoxicity. Kester avoided referencing the sexual problem that he alluded to last week, although he did indicate that he ran into an old girlfriend of six years past. She reawakened quite a few old feelings in Kester, but apparently her current life situation is such that a renewed relationship with her seems improbable.

Tuesday, August 5, 1997
1 pm. Fifth Session with Kester Langford. Kester came in literally bubbling with enthusiasm. His old girlfriend Evelyn was delayed from embarking on her trip--something about the AIDs epidemic in Zaire--and, without putting too fine a point on it, Kester and Evelyn spent a couple of days in bed together. It signaled the end to what appeared to be a long dry period for Kester's sex life. Whatever sexual problems Kester had hinted at during our previous sessions seemed to have resolved themselves under Evelyn's ministrations. He told me that her full name is Evelyn Bliss, which seemed to accurately describe Kester's experience with her. So Kester wanted to keep the mood of our session one of celebration. Indeed, things do seem to be looking up in Kester's life. Kester described the apartment above the gallery in glowing terms and he moved in over the weekend. Evelyn both helped inaugurate the apartment and helped him unpack his possessions. With Evelyn, Kester seemed to connect more than just reviving an old friendship. Kester described Evelyn as a healer and they seemed to have spent much of the weekend working through various emotional issues from their past life. Kester said that they both cried a great deal and, although Kester is comfortable and claims no difficulty expressing emotions through tears, Kester said that this was different, as though the tears were coming from the bottom of his soul. Apparently Evelyn precipitated a great emotional release in Kester. Kester's lab work-up came in a couple of days ago and there was nothing remarkable. Kester is clearly healthy enough to consider a somatic therapy if that's an appropriate course of action. Both Kester and I agreed at this point that medication would not be the right answer at this point. From our last session, I got an impression that Kester was pushing for medication. I believe that he was looking for some sort of hope and the medication was to provide that hope. But Evelyn has now taken on that role for him. Without Evelyn, I think that Kester would have been insistent on medication.

Tuesday, August 19, 1997
1 pm. Sixth Session with Kester Langford. What struck me about today's session was Kester's inability to focus on any one topic. We glanced from topic to topic, stream of consciousness style, without fixing long enough on any subject to be able to analyze his feelings about it. However, Kester was voluble about any number of things and, in fact, said that he was amazed at how much he was willing to open up. We talked about his sexual problem--an awareness that his previously prodigious sex drive is slowing with age. Instead of being disappointed, Kester is coming around to a view that it is a positive that finally his cravings for sex match his body's abilities. Kester also claims to be increasingly self aware, and he finds self awareness through his marks--apparently by examining them after they are created. But Kester's self awareness seems mostly to be a rumination about himself and his current circumstances, rather than any real understanding of his inner emotional states. At one point, he was about to say something interesting--about a feeling of being temporally disconnected, but then he veered off to another topic--his new job as a nighttime security guard. It has disrupted his sleep cycles, which probably has contributed to Kester's inability to concentrate. And apparently, it has disrupted his eating habits as well. I decided to let Kester wander during this session, but next time I'm going to insist on him staying more focused.

Tuesday, September 2, 1997
1 pm. Seventh Session with Kester Langford. Kester received a letter from his estranged brother Chester. As I remember, we talked about Kester's brother a few sessions back. Kester and he had a falling out about ten years ago and they haven't spoken since. Chester is now a born again Christian, and is trying to tell Kester about the joys of finding Jesus Christ. Kester has reacted strongly to this letter. He doesn't see it as an attempt by Chester to help him in any way. He cast Chester in the same mold as zealous missionaries throughout history--committing genocide in the name of furthering religion. We were able to talk a bit about how Kester sees himself and he feels that he is an iconoclast. He wants to be viewed from his own point of reference, without prejudice. Kester told me that he was sick last week. He had a bad cough and terrible headache. He refused to see a doctor on principle. Kester was upset because his boss Jake did not seem to be adequately concerned about his physical well-being, and was instead just worried about filling the role of security guard for the gallery. It seems like Kester is assigning significance to that relationship that really isn't there. He also received a post card from his girlfriend Evelyn, and criticized it for having a cold tone. Kester rejects western medicine, but he wanted to leave the session early to keep an appointment he made with an herbalist.

Tuesday, September 16, 1997
1 pm. Eighth Session with Kester Langford. I keep sensing something almost manic underlying all of Kester's thoughts and conversations. He jumps from subject to subject with practically no transitions. Sometimes, I almost hear the screech of my mental breaks as I try to follow all the twists and turns of Kester's reasoning. He told me of a new relationship he started with a very young college student he met while drawing outside. Meung Kim, or Me for short, was apparently very impressed with Kester's work and even asked to buy a few of his marks. That chance meeting led to a full-on sexual relationship, one which Kester now needs to reconcile with his feelings and friendship for Evelyn--an old girlfriend with whom he rekindled old passion just a few weeks ago. Kester describes this as "either feast or famine." I tried to understand some more about Kester's underlying emotions and motivations for doing his marks. In particular, I wanted to know where the label "marks" comes from. Kester tried to explain that the marks weren't so much an artistic expression as a way of life--each mark marks an event in the history of his life. But Kester clearly sees his marks as having potential commercial value as well. They are not just an alternative form of a diary. He's actively trying to sell his marks and even considers some to be as valuable as $35,000. He seems to value the marks not just based on their artistic merit, but also on the duration of time that he possesses them--the longer the mark stays with Kester the more valuable it becomes to him. I'm pretty certain that if Kester demands $35,000, that particular mark will never leave Kester's hands, but perhaps that's Kester's intention as well. We briefly touched upon the subject of Kester's brother Chester. After the initial anger over Chester's letter subsided, Kester realized that he would have reacted that way to any advances his brother would have made to try to help him. There's some substantial issues regarding his brother that we need to discuss--it sounds far beyond the normal sibling rivalry. Kester told me that he would like to spend some time during our next session discussing his brother. But I know that it's going to be difficult focusing a session on any one subject.

Tuesday, September 30, 1997
1 pm. Ninth Session with Kester Langford. Kester came in late today. He told me that he's feeling very ill--bad abdominal pain and diarrhea. He said that he'd feeling that way for a while. He sought medical help--he went to see his doctor who then ordered a battery of tests for Kester--blood work, an ultrasound, and a sigmoidoscopy. They discovered a tumor the size of a golf ball in his liver, but apparently Kester's physical symptoms and discomfort is not due to that. The tumor is a hemangioma and is unlikely to be cancerous. But it scared Kester. He is worried about his mortality and all the things that he might have done differently in his life. He said that he always envisioned himself having a family, and now it might be too late. He also was interested in reconciling with his brother, which surprised me. Kester still needs to get more tests done before his internist can diagnose the cause of his stomach pain. But the next available opening to do the blood pool scan is in November. I told Kester that I would help him to arrange to take the test earlier--maybe I can talk with the radiologist over at Kaiser and explain how the delay is effecting Kester's mental health. Part of Kester's stomach problems might be due to stress, and waiting for over a month for a diagnosis wouldn't be good for him. Kester was too uncomfortable sitting in the chair, and we had to end our session early.

Tuesday, October 28, 1997
1 pm. Tenth Session with Kester Langford. Kester got positive news from his medical tests--his tumor is benign--but he is completely wrapped up in the impersonal nature of the process. His entire focus is on the dehumanization he felt undergoing a series of tests, rather than on the information that the tests provided. I recently read Oliver Sacks' book, "A Leg to Stand On" in which he describes becoming a patient after suffering a serious trauma to his leg. He was also particularly impressed by the dehumanization of being a patient and said that the experience profoundly affected the manner in which he now practices medicine. I guess it's easy for physicians to become results-oriented and forget that patients see the process itself as a kind of "hero's journey" through a frightening and foreign world where they must confront their own deepest anxieties about mortality. Although very cautious to avoid hurting my feelings, Kester even said that he felt like I was judging him sometimes. I told him that my continuing diagnosis was part of the process but that I also viewed him as a person. That seemed to satisfy him. Kester said that he had a surprisingly pleasant telephone conversation with his brother, Chester. He also said that he has been asked to be in a group show at the gallery, that his relationship with Me is solidifying, and that Evelyn wrote him a "Dear John" letter, which actually helped relieve some of his guilt for not having written her earlier about Me.

Tuesday, November 11, 1997
1 pm. Eleventh Session with Kester Langford. Kester avoided the real burning question in his life for a while with some preliminary game playing, primarily designed, I think, to test whether or not my concern and regard for him is genuine. But finally he told me that his brother Chester has arranged for Kester to take a trip to Paris so that they can meet and establish the relationship that they never had. Kester is torn. He wants to go to Paris--Chester has even held out the additional carrot of an art dealer to represent Kester's work--but he doesn't want to give up all that he has gained. Kester told me that, although he hates the night shift hours that he works at the gallery, he has become pretty comfortable with his life. He cites his girlfriend Me, the place that he's living and the job he has, and the group show in which he is to participate. He's afraid he has to give up all of that to take Chester up on his offer. I pointed out that he can talk to Chester and try to restructure Chester's offer so that it isn't as costly for Kester to accept. He seemed to like the idea, and thought that he could arrange for Me to travel with him if his brother will consent. I tried to explicitly give Kester permission to go, if that's what is holding him back from accepting.

Tuesday, December 16, 1997
1 pm. Twelfth Session with Kester Langford. Kester is coping with a number of disappointments in his life with an admirable degree of restraint and perspective. In the past, I feel that Kester would have found the few reverses as almost overwhelming; now, he seems more resigned to a spate of bad luck. The items which Kester brought to my attention were a break-up with Me that didn't sound particularly permanent, a setback in the renewal of his relationship with Chester, an accusation of eco-wastefulness by an ecology-minded friend, and a delay in his group show. Evelyn, who was going to be married, instead ended in a brawl with her prospective fiance--apparently, he was already married. And another friend told Kester about selling options on stock he buys. Kester was enthuased about earning money on the upside, but I'm not sure he's done the math or considered an investment in which his downside is wide open but his upside is capped. Is it part of my function to advise Kester on his business dealings? Perhaps, if I feel that Kester isn't thinking through a financial proposal. Then my obligation is to assist Kester in making his own decisions but only after a thorough analysis of the problem.

Tuesday, January 6, 1998
1 pm. Thirteenth Session with Kester Langford. Kester feels like he has discovered a world outside of himself as a result of his experience sitting bedside in the hospital while Me's 80 year old aunt Maymilu recovered from a stroke. He says that he's gotten a sense of purpose beyond being a mark maker. Kester sees making marks as a way of giving to others and he also thinks of them as transcending the temporal limits of his lifetime. But caregiving to older people feels more direct, I suppose. Kester says he feels like he has discovered compassion. He compares it to Chester's born again conversion to Christianity. Kester was able to stand up to Chester a bit during a telephone call, which raises a whole host of sibling issues for Kester. But Chester took it with good grace. Kester even told me that Chester had sent him some money, which Kester is using to invest in the stock market. He told me his investments, and they were all either blue chips or mutual funds. I commented that he is investing quite conservatively. I have to admit being surprised that Kester is a player in the market.

Tuesday, February 24, 1998
10 am. Fourteenth Session with Kester Langford. Kester is still suffering from the same disconnectedness of thought that he has demonstrated since the beginning of our sessions together. But he is introspective and seems to be coming up with positive and happy insights into himself, which is propelling him in a socially positive direction. Kester is still enthused about his revelation of the value of assisting the elderly, and he is taking on added tasks in that regard. He's also become comfortable referring to his work as art, rather than simply marks. His self-esteem is clearly up, and I feel that no particular therapeutic benefit would come by my challenging any of his new insights. His relationship with Me is suffering, apparently. Kester thinks that Me is somewhat put off by the new person that he's become, but I suspect that it has more to do with Kester's self-absorption and his inability to relate to others and achieve intimacy. Kester reports that he is feeling less exhausted lately, and that he is getting more relaxed sleep. He has a new sense of energy, probably because he's less anxious. He plans to quit his job at the gallery and take on his work with the elderly full time. He also reports that he has a new sense of his work. Before, he hid behind his mark making as a way of disconnecting himself from life, even as he gave lip service to celebrating it. Now, he sees his art as an adjunct to his relationship to people, which I see as a positive sign.

Tuesday, May 26, 1998
9 am. I received an e-mail message from Kester Langford. Kester accepted his brother's invitation to go to Paris and he's studying there and has been given a work permit by the French government. Kester is teaching English and plans to stay for at least three months. He says that Chester has been terrific, although he still exhibits overt Christian motivations. There's a gallery interested in his work and he's living in a student dormitory for a reasonable price. Kester said that he's trying to convince Me to join him. Kester asked if we could correspond as a kind of therapy. After my experience with Peter Hossfeld, I'm not convinced that e-mail therapy has a lot of value, but I don't mind being a sounding board for Kester's concerns.


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