Transcript of 4th Session between Charles Balis, M.D. and Ms. Sylvia Bows, Tuesday, July 30, 1996 at 4 pm.

Ms. Bows: Hello, Doctor. How are you today?
Dr. Balis: Hello. I am very well, thank you. Won't you please sit down?
Ms. Bows: I am guessing that you are still wondering about Zoloft and me.
Dr. Balis: I am not just wondering. I am concerned. You promised to keep an eye on yourself and tell me about any changes in your behavior.
Ms. Bows: You would be happy to hear that I have been spending most of my time working. I took too much time off and things just piled up. I carefully observed my behavior during meetings and when I worked by myself. I'm relieved to say that Zoloft didn't seem to result in any memory loss or changes in either my attention span or my ability to concentrate. So after a week of careful observations, I'm convinced my ability to perform my duties are unaffected by this medication. Of course, I acknowledge that this is just my opinion. But it is hard to be completely objective when you are the laboratory rat as well as the scientist. But seriously Doctor, I don't think that my cognitive functions have been adversely effected.
Dr. Balis: I noticed that you are emphasizing your work life in your analysis. How about your personal life?
Ms. Bows: You're right Doctor. I am. But there are a lot of changes in my personal life. Please keep in mind that Rene is here and my behavior would have been altered in her presence with or without Zoloft.
Dr. Balis: I'll keep that in mind. So tell me about the changes.
Ms. Bows: For starters, I've been spending most of my free time with Rene. We went out this weekend to find her an apartment in the City.
Dr. Balis: She's planning to move to San Francisco?
Ms. Bows: She's not sure yet. But she would like to spend a few months down here and it seems silly and expensive to stay in a hotel. Ordinarily she would stay with Tom and me,'s much better this way.
Dr. Balis: Did you find anything?
Ms. Bows: I think so. It's not finalized yet. But I think it will work out. It's a small two bedroom apartment on top of Pacific Heights. From the living room and kitchen windows you can see most of the Bay. It's beautiful! And it is also close to the Presidio.
Dr. Balis: Sounds nice.
Ms. Bows: Yes. And I think it's in a good school district.
Dr. Balis: Is that important?
Ms. Bows: Rene has a twelve-year-old boy, Robert. He is a very sweet kid even if a bit too serious at times.
Dr. Balis: Is Robert with Rene now?
Ms. Bows: Robert is with his grandfather, my Uncle Phillip. He spends his summers at the vineyard just like Rene and I used to. Only difference is that he really likes it. Robert wants to be a wine maker just like his grandfather. Phillip couldn't be happier. At last he's found his soulmate and a successor for the family business.
Dr. Balis: Where is Robert's father?
Ms. Bows: He died when Robert was just a baby.
Dr. Balis: So Rene is a widow?
Ms. Bows: I thought I told you that. Rene met Tad in New York. He was mad about her. He wouldn't let anything stand between them including her boyfriend at the time. They got married and Robert was born six months later.
Dr. Balis: If you don't mind me asking, what happened to Tad?
Ms. Bows: One day on the way to work he passed out in the car. The car smashed into a tree on the side of the road. When he came to, the car was smashed up but he was okay. But he went to see a doctor to find out why he passed out. A week later, he was diagnosed with an inoperable brain tumor. He was dead in two months.
Dr. Balis: It's a horrible story. I am very sorry.
Ms. Bows: Me too. I actually liked Tad. Most of the other men Rene associated with were...well let's just say Rene doesn't go for the cerebral type. But Tad was sweet and compassionate. It's a shame that Robert never had an opportunity to get to know his dad.
Dr. Balis: Are you close to Robert?
Ms. Bows: I think so. He's becoming a teenage and it is hard to tell. But when he was a baby, he was the most charming and possibly the cutest child I have ever seen.
Dr. Balis: Sounds like you love your nephew very much.
Ms. Bows: Oh, I do. I love the possibility of living in the same city with him. He is very bright and I look forward to taking him to places like the Exploratorium.
Dr. Balis: Sylvia, I would like to get back to your self assessment of your behavior. You mentioned that in your personal life there has been some major changes. I understand that the presence of Rene is a large change. Is there anything else?
Ms. Bows: Now Doctor, this is where I want you to have an open mind.
Dr. Balis: Okay.
Ms. Bows: As I said, I have been spending most of my free time with Rene. This includes night times. As you can imagine living with Tom the last couple of weeks has been anything but pleasant. Rene thought that I might benefit from just taking a break and living with her for awhile. Frankly, I am surprised that Tom hasn't called you. He hasn't, right?
Dr. Balis: No. Tom didn't call me since our last session.
Ms. Bows: Last week, I only spent one night at home. I just got so angry at Tom for calling you and...I just needed to get some sleep. I think that I feel much better now partly because I don't have to go home and face him. Now I have the option of staying with Rene.
Dr. Balis: You always had an option of leaving.
Ms. Bows: That's true. But it is much easier with Rene around. She just took charge, packed my bags, and told Tom that he has to cope without me for a while. This is not a permanent thing. But I think it is good for the next couple of weeks or so.
Dr. Balis: So you are planning to move with Rene into the Pacific Heights apartment?
Ms. Bows: I think so. At least until Robert comes back from France.
Dr. Balis: How is Tom taking this?
Ms. Bows: I think he is partly relieved. I am surprised he didn't take off on one of his business trips. I think he might have wanted to keep an eye on me or something. He hates it when things aren't under his control. But with me acting cold towards him, I think it made him very uncomfortable. He still thinks that he knows everything that goes on through my parents but he doesn't have to deal with me on a day-to-day basis. I did tell you that he has been talking with my mother almost every day?
Dr. Balis: You mentioned that he was trying to convince your mother that all of his actions were completely for your benefit.
Ms. Bows: Yes. Well, I think she is convinced. She was very effected by Tom's sister's tragic pregnancy story and all of its consequences. I think she looks at me and sees Down's Syndrome, divorce, depression, and unemployment. She's very upset and Tom is taking advantage of it.
Dr. Balis: Why don't you talk to your mother again? You said you're feeling better. Perhaps now it would be easier for you to express your point of view?
Ms. Bows: I will. It's just not time yet.
Dr. Balis: Okay.
Ms. Bows: I didn't tell you about all the changes yet, Doctor.
Dr. Balis: Oh?
Ms. Bows: I had two affairs last week.
Dr. Balis: I think that qualifies as a big change in behavior.
Ms. Bows: Yes, it does. Remember about keeping an open mind.
Dr. Balis: I remember.
Ms. Bows: The first was the evening after our last session. I came back to SII to pick up some papers because I wanted to do some work at home. I went into the copy room but the copy machine on our floor was out of order. So I went downstairs to the engineering department. At six o'clock in the evening, the engineering department turns into a dinner party. Some of our engineers only get to work at this time. They say they can get more work done at night when no one bothers them. They are an interesting and eccentric bunch of individuals. Some of them, when they have an exciting project, sleep on the floor under their desks. Rene was going on a photo shoot that night, so since I wasn't seeing her I got talked into staying for pizza.
Dr. Balis: Sounds innocent so far.
Ms. Bows: Yes. But there's this one young man, David. I have seen him in the past once or twice around SII. He is very handsome and self assured. Not exactly the stereotype of a computer nerd. I'm not sure how it happened, but I ended up in his cubicle. David showed me his latest project. It was good. He clearly had some artistic talent as well as being a good programmer. When I leaned over him to see the computer screen better, I could feel his breath on my breasts. It was very exciting. I moved in closer so his face touched my skin. He kissed me and then his hand started to slowly move up my legs. I was trembling and almost lost my balance. David held me up and I ended up in his arms. I wanted him so much then. We went up to my office and...well, Doctor, I am sure you understand what happened next.
Dr. Balis: I do.
Ms. Bows: The second time was with Rene. Last Friday I took her to work with me to show her SII. Somehow I just never had done that before although she had visited me in San Francisco a couple of times since I started work there. She was only moderately interested and I decided to take her for lunch in a nearby restaurant. So there in the restaurant, sitting by himself, was one of my freelance photographers. Rene is also a photographer so I decided to introduce them. Matthew is very nice. He gave Rene his card and offered her his assistance in possibly getting some freelance work from an advertising agency he was doing some work for. Rene insisted that we all have lunch together. Matthew is very intelligent and witty and I was happy to have his company.
Dr. Balis: So Matthew was next.
Ms. Bows: Yes, Doctor. You're very perceptive.
Dr. Balis: Was it just you and Matthew or...
Ms. Bows: It was the three of us in Rene's hotel room.
Dr. Balis: Had you and Rene ever done this before?
Ms. Bows: Once, when I was still going to NYU, Rene and I made love to one of her artist friends.
Dr. Balis: So I am safe in assuming that this is a large deviation from your normal, pre-Zoloft, behavior?
Ms. Bows: Yes, Doctor. But it is not abnormal behavior. It might be a bit unusual for me, but I want this. I want to break out of my day-to-day life. I want to experience and feel things that are different and new. And, what is most important, I like this. I like feeling the excitement of seduction. It's wonderful and I had almost forgotten about it with Tom. Before I knew about Tom's vasectomy, our sex lives were very much centered around getting pregnant. At least it was for me. Sex almost became like work. Now it is as if I am rediscovering sex. But rediscovering it as an adult who is confidant of her looks and herself and has none of the hangups that adolescence burdens us with. I hope you understand, Doctor.
Dr. Balis: I understand that this is very exciting. But this is not proper behavior for...
Ms. Bows: Doctor! You surprise me.
Dr. Balis: You surprise me, Sylvia.
Ms. Bows: Tell me Doctor, if I were a man would you respond the same way?
Dr. Balis: I...
Ms. Bows: I don't think you would. It's okay for men to have sex and have sex with multiple partners and to pick women up at bars and restaurants. Right?
Dr. Balis: I think it is sometimes okay for men to do this. But...
Ms. Bows: I think it is okay for me to do this right now. It's good for me psychologically. And anyway, Doctor, we are out of time. How about meeting the same time next week?
Dr. Balis: Same time next week? Wait a second, Sylvia. While there is a double standard which I recognize is unfair, that is not at all what we are talking about here. If a man came in here who had been monogamous for years and I prescribed a drug which suddenly caused that man to completely change his sexual behavior and begin engaging in sexual experiments with multiple partners, sometimes at once, I would be concerned in exactly the same manner as I am with you. I might be a bit old fashioned in my views in general, but this is not about your gender. This is about a drug which may be causing an unintended side effect.
Ms. Bows: But a desirable side effect, in my case. Look, if you gave a man some drugs to cure depression, say, and it also increased his sexual interest...or let's make it easy, how about if it cured his acne. It might be an unintended side effect, but you wouldn't discontinue the drug just because it had an unexpected, but desirable, side effect would you?
Dr. Balis: I'm going to have to think about that. I guess in some cases an increased sexual appetite could be a desirable side effect, but I'm not sure that you are getting what you really need from these relatively meaningless sexual encounters.
Ms. Bows: No, you're wrong there, Doctor. I know for a fact that I'm getting precisely what I need.
Dr. Balis: Well, if you like the drug I'm not going to discontinue it right now. And I do appreciate your being honest with me about the behavior changes that you are noticing. I know that it would be easier to just lie about your various encounters and assuage my suspicion. But I would like you to continue monitoring the drug's effects. If you ever feel like you are following a compulsion over which you don't have full control, then we will have to stop the drugs right away. So let's pick up our conversations next week, okay? Will you be staying with Rene?
Ms. Bows: I think so.
Dr. Balis: Can you please call and leave me you new telephone number where I can reach you, okay?
Ms. Bows: Of course, Doctor.
Dr. Balis: Goodbye, Sylvia. I'll see you on Tuesday, August 6th at 4 pm, then.
Ms. Bows: Goodbye, Doctor. Please don't worry about me.
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