Tuesday, July 14, 1998
10 am. Initial Session with Herbert Michel. I met Mr. Michel today. He's a janitor at SII and a low-level drug dealer on the side. He is also an apparent misogynist. He's in a relationship with an eighteen year old woman, Lenore, who works as a cashier at a bookstore. The relationship clearly began when Lenore was under the age of consent. Mr. Michel describes Lenore as both unintelligent and passive. I wouldn't be at all surprised if Mr. Michel was physically abusive towards her. Lenore turns over her paycheck to Herbert and Herbert doles out an allowance. Herbert is a drug user himself, describing himself as abusing mostly marijuana and methamphetamine. He kept wheedling for barbiturates as a sleep aid, and was extremely disappointed when I suggested melatonin, even though he'd never tried it. I got the sense that, if it wasn't a prescription (and preferably a schedule 2 narcotic), Mr. Michel just wasn't interested. He has a fairly diffuse set of physical and emotional complaints: stomach pain, headaches, insomnia, general anxiety, stress, and relationship difficulties. These complaints may or may not turn out to be genuine--perhaps, he was just hoping that I would give him drugs in response. I've had patients whose primary interest in seeing me was to acquire pharmaceuticals they could use recreationally, but usually such patients are cagier than Mr. Michel. They don't often begin by telling me that they're a drug dealer and poly drug abuser. During this first session, I didn't get any kind of family history or patient background, although he did tell me that he was diagnosed as hyperactive as a child and apparently was prescribed Ritalin which his mother took for herself. She dosed him with codeine as a substitute. I'm sure that his family history is going to be unpleasant. Mr. Michel is of average height, perhaps five feet nine inches. He's thin. He has shoulder-length curly red hair, blue eyes, and hadn't recently shaved. His hairline is receding slightly. He has a certain forced affability, with a slight menace underneath his apparently jovial exterior. He wore faded bell bottoms and an old sweatshirt, but he wasn't aspiring to some retro fashion statement. It was clear that he's unconcerned about how he looks. Mr. Michel smelled of stale cigarettes. I couldn't detect the odor of marijuana, but it was early in the day. I was surprised to find out that he was only thirty-one years old. He struck me as a man in his late thirties or early forties. His skin is pale and freckled, although he has a lot of deeply-etched wrinkles around his eyes. Mr. Michel may have just been hoping that I would pull out my prescription pad, but he also may have come to me from some realization that he has more deep-seated difficulties. He struck me as a man whose life is spiraling out of control. Perhaps he senses that and is genuinely seeking some help.

Tuesday, July 28, 1998
10 am. Second Session with Herbert Michel. We covered a lot of ground in our session today, and Herbert seems to understand that he's not likely to get recreational drugs out of me. Herbert was born in Hollywood to a 16 year old rich girl whose mother had died and whose father was horrified at her pregnancy. When Herb was born, Herb's mother left Hollywood and moved to Fresno on her own. She worked as a waitress and sold drugs on the side, becoming a methamphetamine abuser. Herb was physically abused by an assortment of his mother's husbands and boyfriends. Regarding Herb's drug use, she was a permissive mother, allowing him to smoke marijuana in the house from about twelve or thirteen years of age. But Herb says that she drew the line at harder drugs, although that didn't deter Herb much. Herb admits to taking PCP, LSD, methamphetamine, and cocaine, in addition to habitually smoking marijuana. Herb says that he was a bright student who didn't apply himself in school and dropped out. He was making so much money selling drugs while working as a busboy at a chain restaurant that he didn't see the point of staying in high school. My experience with polydrug abusers is that they have a great deal of trouble in standard societal roles of any kind. He was quite candid about his current drug dealing--he said that he sold to half the "suits" at SII. He was also not amenable to having me express my opinion about his illegal activities. But I feel that he's ready for therapy. Although he seems as if he won't admit it, I think that he knows that his life is out of control. I'm not sure, though, just how much self knowledge he really possesses. Rather than seeing himself as a depressing low-life, he seems instead to think of himself as a dashing outlaw, utilizing his wits and cunning to live on the edge.

Monday, September 14, 1998
5 pm. Telephone Call with Herbert Michel. Herbert called me from Reno, Nevada, obviously drunk. He told me he had married Lenore and said both of them were going to come and see me on Thursday.

Thursday, September 17, 1998
10 am. Third Session with Herbert Michel. I just finished a very disturbing session with Herbert and Lenore, now his wife. Herbert was apparently high on methamphetamine. He was verbally abusive to Lenore in my presence and she described some fairly serious examples of physical abuse as well. Herbert gambled away some money which really belonged to a drug dealer--about two thousand dollars worth. From what I hear about drug dealers, he's unlikely to take it well. Lenore was very upset as she saw Herbert gambling away money she knew wasn't his. Herbert took it as a sign she was only interested in nagging him and destroying his enjoyment of the moment. Unfortunately, Herbert is in rather deep. It is interesting to me how much similarity there is between Herbert and his methamphetamine addiction combined with misogynism and Joseph Mazurka--my now deceased ex-patient who had similar problems. I'm hopeful Herbert will follow a different path than Joe did. At one point, as I tried to calm Herbert down, he became convinced I was siding with Lenore (I probably was) and stormed from the office. Lenore was quite calm and logical throughout the session--she's obviously used to the abuse. She clearly adopts a particular protective persona with Herbert because after he left the room, she became a lot more her own person--more forceful and sure of herself. Herbert told me previously she had a father who abused her. She's gone from one abusive man to another. Perhaps she developed the milquetoast protective coloring when she was dealing with her father and now adopts it with Herbert. It's as if she's neutral, somehow. She doesn't break down while he's abusing her, but she doesn't stand up to him either. Perhaps she's found that taking either extreme tends to escalate the violence. In fact, she sat frozen with her arms folded in front of her during most of the time when Herbert was in the room. She is now several weeks pregnant. Herbert wants her to get an abortion, although it's not at all clear that's what she wants. She is attractive in a clean-cut, well-scrubbed way. She is slightly overweight with long brown hair parted in the middle. She has large blue eyes, a round face, and a vacant, naive look while she's with Herbert. There was a lot more determination after Herbert had left. She clearly cares for him--she was trying to justify his behavior towards her and she was also trying to protect him. However, she declined to tell Herbert she loved him when he was attempting to force her to. She told me Herbert takes methamphetamine and then madly writes, creating fantasy characters who seem to overcome his own sense of self. She also told me he plays some fantasy role-playing game in which he is a vampire. She said he has bit her neck and drawn blood and once, she awoke to find him digging into the skin of her neck with a razor blade. Obviously, I was very concerned. Given his propensity for violence, his current penchant for methamphetamine, and his obvious anger and abusive display in my office, I felt Lenore was in imminent physical danger. I therefore gave her the number of Casa Las Madras and urged her to contact them immediately and move out of the house. I also urged her to talk to a therapist other than myself. She said that she wanted to see me. I cited ethical concerns with treating both her and her new husband. But she said that she wouldn't see anyone who hadn't already met Herbert--she was afraid another therapist would have Herbert arrested. I made the ethically disturbing choice to see Lenore again without Herbert's knowledge, using as a pretext the notion that she can give me insight into Herbert which will be useful in my treatment of him. However, it feels a bit like hair splitting to me. I really agreed because I was afraid that otherwise she won't take any steps to leave and she'll be injured by Herbert. As it is, I figure the odds are somewhat less than 50/50 that Lenore will actually leave Herbert and show up for her appointment next week.

Tuesday, September 22, 1998
5 pm. Conversation with Lenore Marconi respecting Herbert Michel. I would have liked to talk to Lenore about the physical abuse she may be suffering at home. But I was torn between trying to help Lenore, who obviously needs my help, and satisfying my ethical obligations to Herbert, who after all is really my patient. I took an uneasy middle path which satisfied no one. Lenore is working two jobs, keeping the money she makes at the second one secret from Herb. She has a very low sense of self esteem and feels that she settled for Herb--the cook from Denny's--because she wasn't going to be able to form a relationship with someone better. Now she's pregnant. She doesn't want the child but doesn't want an abortion either. She's considering giving the child up for adoption. She said that Herb is nasty to her all the time--he acts like he hates having her at home, but he won't let her leave either. For all her self awareness, the truth is that I believe she's depressingly mired in her present circumstances and is likely to do little to help herself.

Thursday, October 1, 1998
10 am. Fourth Session with Herbert Michel. It was more of Herb's abusive shit today. I find it increasingly difficult to respond constructively to what he has to say. I am constantly reminded of Joseph Mazurka--and that didn't end well for anybody. But Herb's not as mentally ill as Mazurka was. He's just an abusive, drug-dealing, methamphetamine-laden hot head. I'm certain that Lenore is in physical danger, but he hasn't communicated anything to me that would lead me to conclude that she's in imminent danger. Without that, I'm powerless to take any active steps to stop him. So I try to gently coax him into a position that's more reasonable towards her, with no success. Herb expressed a great deal of irrational animosity towards homosexuals. He seems like the kind of man who would assault another man merely because of his sexual orientation. Herb thinks that his phones are being tapped and that his house is under surveillance. Methamphetamine users are frequently paranoid, but Herb's observations may be correct. He is in a dangerous and illegal profession. Herb wrote a fictional story about Prometheus, which I found an interesting choice of subject matter. He clearly feels that the ancient Greeks are his personal heroes, and was distressed to learn that many engaged in homosexual behavior. But, what's more, he feels trapped. Herb believes that it's Lenore whose trapped him. I, obviously, have a different take on the matter, although I also believe him to be in a trap of sorts. At the end of the session, after I reminded him of his gambling debts, he became increasingly agitated and sounded desperate and panicked. He decided that he needed to get onto the phone and work his network of associates and left early. I find these sessions emotionally draining and, as much as I think Herb needs the help, I'm not sorry that he only shows up once every couple of weeks.

Thursday, October 15, 1998
10 am. Fifth Session with Herbert Michel. Herb showed up in my office today with two guns and a lot of cash. I really don't like that man. He is quickly heading for a fall, and I'm not sure I'm the person who can stop him. Worse, I think he'll take other people down with him. I'm very worried about Lenore. Apparently, she's still living with Herb, even though she promised me to at least temporarily move out to a shelter. Herb said that Lenore wants to keep the baby--at least she's resisting his attempts to force her to have an abortion. But Herb is keeping up relentless pressure and is threatening to throw her out onto the street if she doesn't submit. I have no way of helping her. I feel like I'm forced to sit on the sidelines and watch Herb self-destruct and take Lenore with him. Herb told me about a big score he made by selling lots of drugs to a fraternity at Berkeley. He said that he never made so much money so fast in his life. But I have this feeling--a mere inkling really--that Herb is being set up. When Lenore came here, she mentioned a few suspicious characters who might be following Herb. And Herb said that the guy who sold him drugs also recommended the place where he should sell them. Herb also told me that his mother is apparently avoiding him. He used to see her at least once a month and they'd talk frequently by phone. Now, she's apparently actively avoiding Herb's attempts to speak with her. Is she involved somehow in setting him up? Perhaps the police have pressured her into helping them build a case against Herbert. I don't know. In some respects, jail might be a good answer for Herb--if he's in jail, he'd have a chance to get off drugs himself. I keep remembering Joseph Mazurka and how he was taken out. Perhaps jail would save Herb from Joe's fate. I hate watching a patient slip away like this, especially when there's basically nothing I can do.

Monday, November 2, 1998
11 am. Conversation with Lenore Marconi respecting Herbert Michel. Herbert is my patient and I have an ethical obligation to act in his best interest. But Herbert is a wife-beater and his wife has now turned to me for help. How far can I go in advising Lenore to criminally prosecute Herbert before I've violated my ethical obligations to him? I must be careful here, and not allow my personal distaste for the man color my judgment. However, I have an obligation to Lenore and I cannot try to shield Herbert from the consequences of his criminal behavior. It's a fine line. Lenore showed up unexpectedly at my office. She'd clearly been beaten--she had a large gash on her forehead and several other facial bruises. Her clothes were stained with blood. I phoned the emergency room at CPMC and let them know that Lenore was on her way, and called a cab for her. I also called the Hamilton House and arranged for her to spend the night there. I've found they're excellent at giving advice to abused women, so I felt less obligated to counsel Lenore to call the police. I did, however, tell Lenore that she had that option and that she could also get a restraining order issued. Lenore is reluctant to have Herbert arrested because she feels that one of his friends will bail him out of jail and then he'll come after her. I was unequivocal in my advice not to return to the apartment, however, and I think she understood. I hope she can find a way to leave Herbert. Incidentally, Lenore's purse was unzipped and I saw the same small cell phone that Herbert showed me at his last session. I thought it odd that she should have taken that, although perhaps it's the same model but a different phone. Maybe when Herbert was flush with money, he bought Lenore one as well.

Thursday, November 12, 1998
10 am. Sixth Session with Herbert Michel. I've got a monster for a patient. I sat through this session, blandly responding to his hideous descriptions of beating and forcibly sodomizing his pregnant wife, and all the while I tried to think of ways to involuntarily commit him or, better yet, to turn him over to the police. But I'm bound by my ethics to stay mute and protect him. Although I think he is a danger to others, especially Lenore, I can't honestly say either that the danger is imminent or that I think he is committable. So I have to pretend not to be shocked while he tells me about the inadequacy of Nikes when kicking his wife's stomach. He told me that he is going to stop taking methamphetamines, which would certainly be a good start. The best I can do is to try to keep Lenore away from this drug-crazed raping violent misogynist. I don't pretend to even know where to start therapy on this guy. The best I can do is try to get him to see how outrageous his conduct is from an outside perspective. But I really hold out little prospect for Herbert getting better.

Monday, December 7, 1998
12 pm. Telephone Conversation with Lana Michel respecting Herb Michel. I got a call from Lana Michel, Herb's mother. She told me that she thought Herb was acting "like an asshole" and that she was afraid for his life. Apparently, she's worried that the people with whom he's dealing drugs are going to harm him. She made it quite clear in our conversation that she has been instrumental in Herb's drug selling education. But she is fearful of seeing Herb because she's afraid that she'll be fingered either by his cohorts or by the police. She made me promise that I'd bring up the subject of his friends during our next session and urge him to avoid danger. I tried to enlist her support for an attempt to get Herb into rehab, but she was no help--she kept insisting that she didn't want him "jailed."

Friday, December 11, 1998
1 pm. Telephone Conversation with Sgt. Tracy Keefe of the SFPD and Ms. Lenore Marconi respecting Herbert Michel. Sergeant Keefe informed me that Lenore bit off Herb's penis, apparently during a forced act of oral copulation. Herb is in the hospital, where they are attempting to reattach his member. They were unable to find the severed part of Herb's penis until they pried open Lenore's mouth--she had retained it there all the way to the holding cell. Lenore is apparently in a state of shock and that's the primary reason why I got the call from Sergeant Keefe. He wants me to treat her. But I cannot. I'm Herb's psychiatrist and, clearly, there is an irreconcilable conflict between their two positions. If I were to try to treat both, I would be in an unsupportable ethical situation. I was always leery of the role that they both desired I take--separate counselor to each of them--but they prevailed upon me and I gave in. Now, I must take a hard line stance. Lenore is subject to criminal sanctions and Herb is likely to be the one pressing charges. I suggested to Sergeant Keefe that he give Lenore a rape test and try to preserve evidence of sexual assault. I also spoke with Lenore and got her assent to voluntary commitment at the California Pacific Medical Center In-Patient Psychiatric Facility. I referred Lenore to Dr. Whitestone, who's particularly skilled in dealing with post-traumatic stress resulting from spousal abuse. After I hung up with Lenore and Sergeant Keefe, I spoke with Dr. Whitestone. I think I made the right choice. She said that she would negotiate something with the police and the district attorneys office to get Lenore released into her care. After a few hours, Dr. Whitestone called me back and told me that she had arranged for Lenore to be released into her custody on the condition that she give the police 24 hours notice prior to releasing Lenore. Lenore hadn't been formally arrested yet, although the police seem to think that she will be immediately upon her release. Dr. Whitestone agreed to keep me informed about Lenore's progress. I felt compelled to give Dr. Whitestone some of the particulars of Herb's problems and his history of abusive conduct towards his wife. She assured me that she'd do her best for Lenore.

Friday, February 12, 1999
1:10 pm. Telephone Call with Herbert Michel. I got a call from Herbert. Miraculously, his penis has been reattached and is functional. Herbert professed his desire to prosecute Lenore to the full extent of the law--he mentioned the gas chamber. I pointed out to Herbert that Lenore would be able to make a credible case that she had been raped and would not only claim self-defense but would also disclose his drug-dealing. Herbert was outraged that raping his wife could be considered a crime and he thought it grossly unfair that a drug dealer should be accorded so little sympathy by the court system. However, he ultimately understood that my advice wasn't meant to take sides against him but rather was intended to get Herbert to fully understand the consequences of his action. If it happened to help Lenore avoid criminal prosecution, so much the better.

Monday, February 15, 1999
10 am. Conversation with Lenore Marconi. I was at the hospital and I decided to go and visit Lenore. She's staying at CPMC's inpatient psychiatric facility. If I were following strict ethical rules, I probably would have avoided seeing her because of her adversarial relationship to Herbert. But the truth is that my sympathies are with her and not with Herbert. I can do more good with her than with him, although I clearly can't treat her as a patient--and she's Dr. Whitestone's patient now. Our conversation was strange. She told me about the events which led to her to sever Herbert's penis. She said that after a few weeks living in a women's shelter, she went back to the place where she and Herbert had lived to get a few of her possessions. She went at a time when she thought that he wouldn't be there, and he wasn't when she arrived. However, while she was there, he came in and discovered her there. He raped her, causing her substantial physical injury--she thought she would lose the baby. After forcing her to engage in intercourse, he began to orally sodomize her. That's when she said that she realized how much she hated him--and it's when she bit down hard, severing his penis. She told me that retelling the story made her feel like she was reliving it--and yet, she told the story in a strangely detached way, as if it had happened to somebody else. Lenore is concerned about what is going to become of her and her baby--she's currently seven months pregnant. She believes that she's already lost her job and doesn't know whether she'll be jailed after she leaves the hospital. She is clear that she doesn't want to return to Herbert. She was examined by a police doctor who took a rape kit on her and documented clear evidence of sexual assault. I think that should stand her in good stead if Herbert insists on pressing criminal charges against Lenore. She's also been diagnosed with genital warts and is afraid that they'll affect her baby. I urged her to focus on the present, to get better, and then to seek the services of an attorney through legal aid. Lenore doesn't seem to be connecting well to Dr. Whitestone, so I also promised her that I would help her find a therapist that she would be able to talk to.


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