Charles Balis' Journal for the Week ending 9/20/96

Saturday, September 14, 1996

Sunday, September 15, 1996

Monday, September 16, 1996

9:30 am. Telephone Conversation with Sarah Wright. Sarah has a sinus infection and so cancelled our session. She said that she hasn't had any side effects attributable to the alprazolam, nor any effects at all for that matter. We rescheduled the appointment for next week.

12 pm. Third Session with Phylis Birch. I was met at the door to the office by Martha, Phylis' alter ego. I wouldn't have suspected that someone with the tremendous physical attributes of Phylis could make herself so totally unappealing. But Martha is a frump. She walks differently, as though life has beaten her down, and she looks up from eyes that are filled with pain. Phylis is quite a convincing actress. Phylis wanted the session to be about Martha, so Phylis played Martha during our time, although she was careful to let me know that she was just playing a role. I think she was worried that I might think she was a multiple personality. Martha's character has a 13 year old daughter who is living with an ex-husband in Minnesota and with whom Martha has been forced to have little contact. Interestingly, she populates her story with many details except the name of her ex-husband. When I questioned her on this omission, she explained that she didn't want to make a slip and substitute the name of her fictional ex-husband with that of Jack. But perhaps that is exactly what she did in our first session when she came up with the name Frank instead of Jack. Phylis all of a sudden ended our session over my objections to go hang out in some dive. I guess she wanted to take advantage of the fact that she was in make-up, but it was rather odd.

4 pm. Ninth Session with Joseph Mazurka. I've never felt so ineffectual in all my professional practice. Mazurka is clearly at the edge and, short of calling the police and having him involuntarily committed, there isn't a damn thing I can do about it. He's making threats against me, Carol, himself and the world in general, but the threats aren't of the specific, imminent harm type that would support an involuntary commitment. I tried to get him to agree to a voluntary commitment, but he is afraid that it will appear in his permanent record and he's savvy enough to realize that he may have trouble getting out again. We began with Joe accusing me of having an affair with his wife. Then he described one of the nightmares he's been having lately. It's a wet dream, actually, involving sex with rotting corpses, sometimes his mother. I've tried to convince him to stop taking the amphetamines, but pointing out the obvious physical deterioration that he is suffering is fruitless--he is hell bent on destroying himself through substance abuse. Trying to suggest a positive alternative future without Carol was to no avail as well. I'm really at a loss to devise an effective strategy to deal with this very sick patient.

Tuesday, September 17, 1996
4 pm. Tenth Session with Sylvia Bows. Sylvia came in looking much better than I have seen her previously. While I won't say that she was glowing, she did look in much better health and spirits. She thinks that the Sinequan I prescribed may be helping her anxiety, listlessness, and sleep disorders, although I think it is a little early to be expecting such dramatic results. Sylvia is very concerned about breaking the news about the twins to Tom and to her parents. She has decided to postpone her parents, figuring that they will eventually accept and welcome the news. But Tom she can't postpone. She has moved back in with him and they are coexisting with a certain degree of hostility. Apparently Tom lost control at one point and started to denounce Sylvia, her promescuity, her intellect, and me--he said that he should sue me. Sylvia said that Tom had never seen her cry, so when she started to, Tom got very quiet and left the house, not returning until the following evening. Her lawyer has advised her to get a restraining order against Tom, mostly as a tactic rather than for any protective function, but Sylvia is resisting. She thinks Tom is capable of hurting her, but not physically. She doesn't believe Tom would ever resort to violence against her. Sylvia wanted me to explain to Tom about her pregnancy and desire for a divorce. I told her no. Sylvia also hadn't considered the possibility of dual paternity and hadn't realized that there may be some consternation among the men she slept with at SII. No one at SII knows about Sylvia's pregnancy except Cassie, apparently. At my suggestion to have Rene present when Sylvia talks to Tom, Sylvia said that Rene was very volatile emotionally and may not be the best choice as an arbitrator. I pointed out that she was really looking for a protector.

5:30 pm. Telephone Conversation with Cassandra Evans. We had scheduled a session by telephone during our last session. I can't say that it was completely satisfactory. It's amazing how much difference it makes to be in the room with a patient during a session. In any case, Cassandra is still having vestibular difficulties with movement, balance, and nausea, potentially as a result of the Prozac. So I discontinued the Prozac and will start Cassie on Zoloft during our next session. Cassie is unhappy with Brian because he doesn't make her happy. She has a recurrent character in her dream--a man with smoldering eyes who sees through her soul--that makes her wake happy. Brian suffers in comparison. But Cassie sees herself as "damaged merchandise," given her medical condition. Cassie has yet to tell anyone about her diagnosis except for an aunt who questioned her sharply about her slurred speech on the phone. But I listened closely and couldn't detect any slurring of Cassie's speech.

Wednesday, September 18, 1996
I received another anonymous fax today. Again, right on schedule. This one does away with any attempt at personalizing the fax, but it fits in with my theory that the male figures are tortured and the female ones are serene. The faxer has a highly stylized view of gender distinctions. Here is a tortured male figure, half man, half spiky lizard. The man's lower extremities are completely lizard, while his upper arms seem to be in a state of transition--clear fingers but webbed with claws. His neck is skewed agonizingly to one side. His right arm is nowhere to be seen. Compositionally, the image is crowded to the lower left hand part of the frame.

I got a call from Cassie. What we talked about was inconsequential--about her health insurance's bill--but I did notice that she was slurring her words slightly. I thought it odd that she would still have some adverse effects from the Prozac after we had discontinued it 24 hours earlier, but perhaps the effect will go away after she has stopped the Prozac for a longer period.

Thursday, September 19, 1996
I wrote a letter to Bill Bennett. It's been a long time since I wrote him and I told him about my various patients and concerns on each. I hope that he will offer some perspective, especially on Joseph, Sylvia, and Helen.

4 pm. Twelfth Session with Anna Green. I've been rereading my notes on Anna and my other patients. They are so dry. They don't begin to give a sense of what these people feel like--what they are about. My goodness, it's as if I'm writing these notes for some board of review or something. I'm trying so hard to stay impartial that I'm losing the sense of what these notes should convey. Well, with Anna it seems that it would be inappropriate to try to stay in that strangling mode. These notes are for my eyes only, so to speak, and I should try to get something of these people's souls into them. Anna--oh sweet Anna. I've tried to describe her in terms of what is happening to her life, but I find myself increasingly infatuated with her. I'm not sure why, actually. I have patients who are more attractive, although she is very attractive. I have patients who are smarter, although she is very intelligent. But there is something about Anna that makes me want to fold her up in my arms. And there is something, if I am going to be honest with myself, which excites my lust. Perhaps it is something in her voice. Perhaps it is a look in her eye. Whatever it is, I feel myself falling into an abyss relating to her charms. I stopped writing down my dreams because I thought they were getting out of hand, but denying them simply won't work any longer. I went back to the American Psychiatric Association rules of professional conduct and reread the section on sexual relationships with patients. The rule is harsh and absolute--once someone has been a patient, they can never be in a sexual relationship with their therapist. It doesn't matter whether they stop being treated by the therapist, it doesn't matter how seductive they may be, it doesn't matter whether the therapist marries the patient. Never, under any circumstances, can a patient or former patient ever be a sexual partner of their therapist. This is a good rule which I support. A patient can be so vulnerable to an unscrupulous therapist--they've laid themselves bare--that this rule must exist. But it can be hard to live by. This session was a good example. Anna came in and told me about how important I was to her. She told me that she is having long imaginary conversations with me reminiscent of her long imaginary conversations with Bill when she first started. She is clearly undergoing transference. Although she didn't explicitly say so, she seemed to be asking me if I was thinking about her outside of our sessions. I told her that, of course, as her therapist, I was thinking about all my patients, but she was clearly unsatisfied by that attempted diversion. She wanted to know my dreams as a man and not as a doctor. Oh, it would have been so inappropriate to tell her what she has inspired in me! I changed the subject again, and got her talking about a dream she had when she was thirteen--something about being an alien protector of the earth and flying over Europe. She remembers being carried through the catacombs of Paris by a character who she later recognized as Jean Valjean from Les Miserables. But the dream was important to her--even triggering sense memories. Although this dream was not explicitly sexual, it has strong similarities to the powerful stranger of her previously described sexual fantasy of being made love to in a crowd by an unseen stranger standing behind her.

Friday, September 20, 1996

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