Charles Balis' Journal for the Week ending 10/4/96

Saturday, September 28, 1996

Sunday, September 29, 1996

Monday, September 30, 1996

12 pm. Fifth Session with Phylis Birch. Phylis was very upset about a young woman whom she met at one of her bars. Apparently she strongly identifies with this young woman, just graduated from college with a degree in International Relations, who is reduced to a job at Noah's Bagels and spends her free time drinking in sleazy bars. Phylis apparently thought she was seeing the beginning of a life going to ruin, which affected her more strongly than seeing already wrecked human lives. Perhaps the young woman represents an alternate future for Phylis if things had turned out differently. Perhaps her agitation over this woman is a key to figure out the fascination that dive bars have for Phylis. Perhaps Phylis will be able to contrast the girl's unhappy prospects with her own life. Phylis loves her husband Jack and her work. She may place a greater value on these elements of her life if she can see what might have been had she lacked them. She is much closer to telling Jack her secret than she was during our first couple of sessions. I think now she is looking for an appropriate opening to bring him into her confidence.

2 pm. Third Session with Sarah Wright. Sarah complained of a series of symptoms--crying spells without warning, mental anguish, a sense of losing her mind--classical anxiety symptoms. She explained how she has been living a lie with her husband Jeff--a loveless marriage where she feels under an obligation to play the role of the loving wife because Jeff saved her from a tough predicament when she found herself pregnant by Robby. Sarah believes that Jeff is unaware that the role she has assumed for his benefit is anything other than completely genuine, and Sarah wants to keep it that way. At the same time, Sarah believes that her destiny lies with Robby. She believes strongly in reincarnation and believes that her soul and that of Robby are destined to be together--that they were kept separated from each other in past lifetimes. It is certainly true that they are being kept apart in this lifetime--Sarah by the bondage of her obligations and Robby by his sexual preference. I believe that the stress of sublimating her own personality (she describes the real Sarah, which she says comes out with Robby, as crass, opinionated, and sassy while Jeff's Sarah is the soft-spoken, non-opinionated wife and nurturing mother) to satisfy her obligations to a man whom she respects but does not love, is now surfacing in the form of these anxiety attacks. She even mentioned that she has thought about suicide, although she believes she lacks the "courage" to take that step. She gave me the business card of her cardiologist. I'd like to talk to him about my prescribing alprazolam tablets (Xanax?) to treat her anxiety attacks. This is a patient who might need medication in the short term, but whose continual stress caused by acting a role is bound to cause further physical difficulties.

7 pm. Telephone Call from Sgt. Tracy Keefe of SFPD respecting Joseph Mazurka. Sgt. Keefe called again. Talking to cops makes me feel so nervous, like I've done something wrong or something. I can almost feel my palms sweat. I'm sure that my eyes get shifty or something. It's so juvenile. Authority figures with lots of power make me nervous. Burger would say it was faulty toilet training or something. In any case, they are concerned because Carol Mazurka and the kids have disappeared apparently without a trace. The police suspect Joseph of murdering them, apparently. For all I detest Joe, I can't imagine that. Carol maybe. But not the kids. At least I hope not. Keefe made threatening sounds about subpoenas and search warrants and my notes of patient sessions, but what he was really looking for was my assurance that Mazurka hadn't confessed to a killing to me. I told him that Joseph has not told me that he killed his wife and kids. I told him that Joseph gave the impression of someone who missed his family. Should I have held fast to principle and not divulged anything? Paradoxically, if Joseph had told me that he was guilty of such a crime, I would be ethically bound not to have revealed the fact during this telephone call. Am I less culpable because the information I divulged was not such a bombshell, and not so vitally important to the police? My gut tells me that Carol packed up the kids and got out of town. Joseph is a violent sociopath and I can't say that I blame her.

Tuesday, October 1, 1996

4 pm. Twelfth Session with Sylvia Bows. Sylvia heard me sneeze and was very concerned that I might have a cold. I reassured her, but it was clear that Jeorge was right about her being jittery, although I didn't notice her hands shaking as he described. I decided to confront Sylvia about Jeorge's revelations gently over the course of the session, so first I probed gently, asking her if there was anything in her pregnancy that especially concerned her. She clearly lied to me, by saying that there was nothing particular, beyond the fact of her unusual twins, and that as she passed each week she felt that she had passed a danger milestone. But she didn't mention the problem of her incompetent cervix. So I probed more and I mentioned the fact of Jeorge's phone call. Sylvia was clearly surprised that Jeorge had called me, although she tried to quickly cover. Sylvia told me that he showed up uninvited at SII in a theatrical manner, angry and insulting, and embarrassed Sylvia before her office staff. So I asked Sylvia about the cervical cancer and Sylvia admitted it, but said that the difficulties of carrying the twins to term was just one of life's risks--she was willing to take the risk, although she would try to minimize it. Sylvia is taking a set of reasonable steps to reduce the pressure on her cervix, including having a stitch to reinforce the cervix. She accused me of liking Jeorge, implying that I could take her side or Jeorge's and the rest of the family. She told me at one point that she could do it alone and fight all of us. Sylvia is feeling defensive and backed into the corner. I suspect she is lashing out because she is feeling a bit guilty about the whole thing. I bet she does believe that Tom is in love with her and that's one of the reasons that she didn't get a restraining order that her lawyer recommended. Now I wonder about Tom. Could Tom be a victim in this whole thing? I've gotten so used to thinking of Tom as the villain that it takes some reordering of my thinking to see Tom's side. Sylvia is clearly incapable of it, but I think that Tom might be wondering what he did that was so wrong. I ended the session by confronting Sylvia about her lies to me. Finally, she admitted that she deliberately gave me the impression that Tom had pretended to go along with her effort to get pregnant which she justified by saying that Tom knew she wasn't taking birth control pills. When Sylvia accused Tom of being controlling, I pointed out that Sylvia was one of the most controlling people I knew. Sylvia was taken aback, I think, but said that she decided to take my comment as a compliment.

Wednesday, October 2, 1996

Another fax was waiting for me when I got in this morning. This one depicts a naked man's back and shoulder and head turned towards the left. He has tears on his cheek. He is looking at either a picture or into a mirror and there is the face of an attractive, calm woman staring directly back at him (although he is looking off to the side). The picture or mirror is hanging from the wall by thick chains which appear to be entangled with a bear trap. Could the woman be a picture of a lost love? Or is he staring into a mirror confronting some feminine portion of his own personality? The bear trap is too obvious a symbol of confinement and entrapment to ignore, but is he enslaved by the girl in the picture or is he trapped himself? Animals captured in these kinds of traps often chew off their own limbs to escape. Is this a hint of self mutilation? Could there be someone wishing to change their gender behind these faxes? Rightly or wrongly, I find myself identifying the faxer with the male figures in the images--In this image, it is clearly the man who is the subject, not the reflected woman. The faxer is drawing about himself. I find myself thinking about the faxes before I come in on Wednesday, looking forward to them. If they didn't come, I think I would be disappointed somehow, and even worried. Although I am probably not the only recipient of these faxes, the person who sent them is clearly asking for help and finds it easiest to communicate through this visual mode.

Thursday, October 3, 1996

Received a letter from George Eisenstadt. I had almost thought these goons had forgotten about me, but no--they've cooked up a whole new scheme to make sport of me. They've concocted this elaborate form that I am to complete on each new patient and on all of my current ones every four weeks. I am supposed to certify under penalty of perjury about a host of mental conditions and give my opinion as to a person's general mental state. The form is machine readable too--I get to press hard and use number 2 pencils. The form is ludicrous. It clearly was not created by a medical professional. Do they assume that I can squeeze my patients into little check marks on a page? They might as well have asked me: "On a scale from 1 to 10, rate the patient's sanity." "On a scale from 0 to 100, what is the likelihood that the patient will suffer a mental breakdown?--In the next two months? In the next three months?" It seems that some lawyer must have told them that they have more liability having a therapist in the HMO plan that not--they are desperate to cover their ass in case something goes wrong. As much as I hate to admit it, with employees like Joseph Mazurka, they might be right. I think I may take the turtle approach. Perhaps if I ignore them and pull into my shell, they'll go away.

4 pm. Fourteenth Session with Anna Green. Anna made her sexual interest in me plain by starting with a story clearly designed to get a rise out of me. She went to a club in the East Bay and danced and drank until 2 am with Caren. They picked up some young college freshman and decided to go swimming in a lake that, needless to say, was closed at that hour. They all went swimming naked after nearly being caught and ended up in a ménage à trois on a platform in the middle of the lake. Finally, I confronted her. I told her that I thought it best if she switch therapists because I was only provoking a sexual response from her. Well, Anna lost it. I mean she really lost it. She couldn't breathe she was sobbing so hysterically. She frightened me with the violence of her reaction. Suffice it to say that it didn't go over well. She begged me not to "give her away." And she said that she knew she was a "bad girl" and promised "to be good." Of course I backed down--what was I to do? We'll see how it will work out.

5:30 pm. Ninth Session with Cassandra Evans. Cassie is worried about losing her job because of missed days of work. She missed work today and came to her appointment by cab. Her friend Michelle is planning a visit to San Francisco and called Cassie brimming with exciting plans for the two of them. Cassie was at a low point and wept over the phone to her friend. Michelle was very sympathetic and said that she is going to do some research into CFIDS (Chronic Fatigue and Immune Dysfunction Syndrome) for Cassie. The reaction of the nasty girl from the improv group to Cassie's confession about her illness still haunts Cassie. Brian is becoming a non-entity in Cassie's life. She told him about her illness over the telephone and he apparently related it only to himself--"Is this why you won't sleep with me? Is it contagious? How could you put me in harm's way?"--until Cassie hung up on him. He has called and left messages apologizing, but Cassie won't return his calls. Cassie says that she doesn't know if she loves him or even if she could love him, but she is concerned that she won't be able to do better because of her illness. Oh, Cassie came up with another name for CFIDS that I liked better--myalgic encephalomyelitis, or muscular pain resulting from a viral infection of the central nervous system. Cassie confessed to not liking the name Chronic Fatigue Syndrome as well--it seems to trivialize the disease. Cassie is thinking about a roommate to help her out in return for cheap rent, which makes some sense. And Cassie likes Dr. Halsey, who is boning up on CFIDS for her benefit. She railed against some overpriced predatory specialist in CFIDS and feels that Dr. Halsey is much more human and probably just as good. I was actually pleased with Cassie during this session. Although she was very weak and sat in the chair without much animation, I could tell that she has a new determination about her condition and coping with it. I think she's slowly learning to channel her aggression constructively. Perhaps eliminating Brian as a distraction was a good move on her part.

Friday, October 4, 1996

12:15 pm. Telephone Conversation with Hal Mainor. Hal called me in a panic over Sylvia. He's noticed that she's pregnant and he's sure that he is the father. More than that, he thinks that Sylvia is punishing him at work because he told her that he couldn't have a relationship with her. Sylvia, if I remember right, thought Hal was sweet but really wasn't interested in him at all. Now all Hal can think about is the paternity suit that he is sure she will file and that will destroy his marriage and his life. I guess the baby could be his, but Sylvia doesn't really care. I told Hal not to invent problems for himself.

4:30 pm. Telephone Conversation with Dr. Brian Malleson. Sylvia's obstetrician called me quite upset about what he called a situation in his examining room with Sylvia. Apparently, he needed to change the appointment from Monday to Friday, so his receptionist left a message on the Bows' answering machine. Well, Sylvia is in stirrups undergoing an ultrasound examination when in walks Tom. Sylvia, to use the appropriate medical term, freaked out. Dr. Malleson was clueless about the current situation between Sylvia and Tom and assumes that Tom is the father. He couldn't quite understand Sylvia's reaction and attributed it to the Sinequan not being effective. I had noticed Sylvia's jumpiness at the last session in any case, so I agreed to increase Sylvia's dosage to 100 mg. once a day. But Sylvia's reaction doesn't sound so incomprehensible under the circumstances. And now Sylvia doesn't need to be concerned about how she is going to tell Tom about the twins. He played it very cool as he found out the news--pretending to already know. But Dr. Malleson did notice that he seemed a bit shaken.

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