Transcript of 6th Session between Charles Balis, M.D. and Ms. Cassandra Evans, Tuesday, September 3, 1996 at 1 pm.

Ms. Evans: Hello Doctor.
Dr. Balis: Good day, Cassie. How are you doing?
Ms. Evans: Okay, I guess. Well, not really. I am a mess, a walking disaster area. I feel terribly sick and achy. I didn't make it into work today. I almost canceled our appointment. But if I had to sit all alone in my apartment feeling like this, I would be crying hysterically. I don't know what to do with myself anymore. I'm terribly exhausted, but I can hardly sleep. I have trouble walking because of the pains in my joints, muscles, and skin. I'm terribly uncomfortable standing still, sitting, and lying down. I have chills and hot flashes. I'm falling apart at the seams!
Dr. Balis: The tissues are on the table beside you, if you want them. Take a deep breath and we'll go on.
Ms. Evans: Okay. I'm sorry for crying like this. I don't know who else to turn to. You've been so good to me and I really appreciate it.
Dr. Balis: That's what I'm here for. Don't beat yourself up for not feeling well.
Ms. Evans: I'm so scared to lose my job. How will I support myself? Did you hear about SII's medical reviews? They are looking into people's files or something. It can't look all that well that I am seeing a psychiatrist, and now an internist, plus missing work so regularly. What am I going to do?
Dr. Balis: Take each moment as it comes, one problem at a time. We are here to try to help you work things out.
Ms. Evans: Have you ever heard of Serenity Prayer?
Dr. Balis: "God grant me the serenity to accept the things I cannot change, the courage to change the things that I can, and the wisdom to know the difference." Is that the one?
Ms. Evans: Yes, that's it. Sometimes I just feel like giving up to a higher power. But it's one of those things that are easier said than done. It's so unfair! Life was not supposed to be this way! I worked hard to get where I am and I'm a good person. So why is everything so messy, so difficult? I don't understand. And if I don't understand, how the hell am I supposed to accept it?
Dr. Balis: It's important for you to come to terms with the fact that you have an illness, and a disabling one at that. Do you think you can ultimately accept that?
Ms. Evans: If I knew what was wrong with me then yes, I think I could accept it.
Dr. Balis: Do you think you'll feel better after you have been properly diagnosed?
Ms. Evans: I suppose it would make me feel better. A couple of years ago, I was friendly with this girl. I told her everything. All about my high school-home instruction experience, being ill, and so on. Anyway, she asked me what I was suffering from if I was so sick. I told her it was undiagnosable at that point, and told her about the hundreds of doctors I'd seen, the different tests and treatments I had tried. She asked me if I was suffering from Munchausen's Syndrome. Have you heard of it? I wasn't sure what that was, so I simply told her I didn't think so and looked it up when I got home. Do you know what that is? It is some disease that you pretend to have in order to get attention from being sick. I was so hurt and so angry at the same time! What kind of an idiot would choose this lifestyle? How insensitive can a person be? And the thing is, right now even if that is what I'm suffering from, I'd be thrilled. At least I would have a diagnosis, a prognosis, and a treatment plan. Now I have nothing!
Dr. Balis: You're talking about something that we call Factitious Disorder. It's a conscious effort to deceive doctors so that they can assume the sick role. But it's done on purpose. From what I can tell, Cassie, you're a very smart young woman. Are you pretending to be sick?
Ms. Evans: No! Not at all! I want to be normal so badly. What I would give to be average. I don't want this attention! I want a regular life!
Dr. Balis: That's what I thought, Cassie. I have no doubt that you are generally suffering and that you aren't pretending to be sick to gain attention. Have you heard back from Dr. Halsey yet?
Ms. Evans: I spoke with his office this morning. I have an appointment with him tomorrow afternoon. I'm feeling a bit ambivalent about the whole thing. Each time I go through the process of seeing a new doctor, there's this great hope that an answer or a clue will be uncovered. I just don't want my hopes to be dashed yet again.
Dr. Balis: There is nothing wrong with cautious optimism. I believe that Dr. Halsey is a very responsible and thorough doctor. He'll do his best to help you.
Ms. Evans: I suppose.
Dr. Balis: Tell me, how was the rest of your weekend? Did you see Brian?
Ms. Evans: The weekend was truly yucky, to say the least. Feeling this way and not being able to shake it is the pits. I did see Brian. He came over with a pizza on Sunday. Actually, he called Sunday morning and did his usual invite himself over to dinner thing. I was in such pain that I had no tolerance or patience to deal with his crap. So I told him that he obviously just didn't have a clue as to what I'm about and to fuck off. Then I hung up on him. I think he was slammed by my reaction. I never did anything like that before, so he knew he was in the doghouse in a big way. He tried calling back, but I was screening my calls. He must have thought at first it was a joke because he was giggling saying, "C'mon! You can't be serious, Cassie." The next thing I know, he is at my door with a dozen red roses, a video, and a pizza. I was flabbergasted! The guy actually bought a clue! Go figure. We didn't watch the video, I wasn't up for it, but the pizza was good.
Dr. Balis: Did you have a good talk with him?
Ms. Evans: I don't know. I wasn't thinking all that great, and half of what I say goes into one ear and out the other anyway. I was ready to call it quits. Sometimes, I don't think he's worth all the trouble. I don't have enough energy to get my things done, why add frustration and aggravation to that?
Dr. Balis: But how do you feel about Brian? When we first talked, you said you thought you loved him. Do you still feel the same way?
Ms. Evans: I do care very much for Brian, and I'm sure I always will. I think I may be in love with him. I don't know for sure. Right now, I just don't want anything too complicated or emotionally draining. Is that wrong of me not to want to make any commitment to him?
Dr. Balis: As long as you are honest with him, no. That is simply what you feel right now. It does not require a good or a bad label.
Ms. Evans: I know. I wouldn't want to hurt him or anything. I just have this huge thing hanging over my life right now. Plus I had this really weird dream the other night. I was walking through a long hallway, and there were two doors. One door was slightly ajar, so I peeked in. Brian was sitting at a desk taking notes off a blackboard. The room was empty, but spit-balls kept flying toward the front of the room and handwriting magically appeared on the blackboard. I backed off and bumped into a door behind me. This door was locked. I crouched down and tried to look through this peephole. Then I felt a tap on my shoulder. It was this man who took me in his arms and kissed me passionately. It was so intense! All I could recall when I woke up were his eyes, these smoldering blue-gray eyes. It just got me to thinking, what if Brian isn't the right man for me?
Dr. Balis: Hmm. I think it's more important that you're happy with the way he treats you and the way you feel with him.
Ms. Evans: Well, I think this weekend gave him some food for thought. That I need and want him to respect me as well as treat me properly.
Dr. Balis: Very good. That is certainly a step in the right direction. Unfortunately, our time is up for today, Cassie. I do want you to let me know how everything goes with Dr. Halsey. Let's schedule a meeting for the same time next week. That's Tuesday, September 10th at 1 pm. If anything new happens, and you need to talk, please call me, okay?
Ms. Evans: Yes, Doctor. Thank you. Have a good week.
Dr. Balis: You too, Cassie. Bye.
Ms. Evans: Goodbye.
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Button to Dr. Balis' Notes Doctor Balis' Notes on this Session

Button to Cassandra Evan's Transcripts Transcripts of Cassandra Evans' Therapy Sessions
Button to Cassandra Evan's Patient File Cassandra Evans' Patient File

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