Doctor's Notes on Joseph Mazurka

Thursday, July 18, 1996	10 am. Initial Session with Joseph Mazurka. Mr. Mazurka starts paranoid that people are going to be rummaging through my desk for information on him. Mazurka doesn't have any problems, except that everyone he comes in contact with is against him. Mazurka is complaining of shoulder and arm pain. As an initial matter, I concur with his doctor (Wilson) that his pain is psychosomatic. Mr. Mazurka left the session early and with evident agitation after I followed up on his reference to masturbation. I think it was an act, and I expect to get a call from him next week. Some patients like to play the testing game.
Friday, July 19, 1996	Joe Mazurka called and made an appointment for Monday.
Monday, July 22, 1996	4 pm. Second Session with Joseph Mazurka. Mr. Mazurka, 33, strikes me as a full blown misogynist, but still I find myself feeling sorry for him. He describes his wife as a "manipulative bitch" who "screwed her way into a meal ticket." Apparently, he married her when she became pregnant during college. His two children, a boy and a girl, he describes as "broken rubbers." He admits to not being a very good father, and I believe it. He accuses his wife, whom he refers to as "the bitch", as turning the kids against him and putting him down in front of them. He complains that his shoulder hurts, of gastrointestinal distress, back pain, and intermittent impotence. He describes sexual relations with his wife as infrequent. He has been consorting with prostitutes and having increasing difficulties maintaining an erection. I would guess that his shoulder pain and impotence are psychosomatic responses. Mr. Mazurka wishes to blame everyone else for all of his problems. The fact that he is coming to these sessions is probably the first time he has acknowledged any responsibility for his own mental well being. Still he is resisting treatment, although he has agreed to come to future sessions.
Thursday, July 25, 1996	Joseph Mazurka's Personnel File indicates that he was hired because he was good at socializing with clients. He is described as a "strong closer." He was a lateral hire from Zephyr Electronics, who wouldn't give him a job recommendation. He is also mentioned as being coarse. He was told to be less aggressive. Then there is one complaint from a Ms. Stephanie Roberts who said that Joseph Mazurka verbally harrassed her by telling obscene jokes in front of her and making obscene comments about her. Mazurka didn't deny the allegation exactly, but the problem resolved itself this time when Ms. Roberts quit and moved, apparently without intitiating legal action. A reprimand was put in Mazurka's file.
Monday, July 29, 1996	4 pm. Third Session with Joseph Mazurka. Joe reports feeling worse, like he is a zombie and not really alive. He reports his physical pain being reduced, but his extremities being numb. He says he has a feeling like he doesn't care about his limbs (paresthesia?). Mazurka related a dream about a baseball game where he is about to become sexually involved with Suzy from work when the ball is hit his way. When he touches the ball, it falls apart and drips blood. He said he wanted to consummate his experience with Suzy in the dream so that he could tell her about it. I mentioned sexual harassment and counseled him against telling Suzy about his dreams with her that have sexual content. To illustrate his bad temper, Joseph then told me about an episode in his childhood where he was in a confrontation with an older boy and suddenly found himself with his hands around his neck repeatedly smashing his head into the blacktop. They took the older child to the hospital. He said that it gained him respect in the school. Since then, Joseph keeps it bottled up and his wife and kids stay out of his way when he is in a bad mood. Apparently, Joseph was physically abused by his father who also abused his mother. When Joseph's father died (after Joseph's childhood), Joseph reports that his mother was happy. Joseph says that his mother was strict but not a mean drunk, like his father, who used to have drill sergeant rituals with his children which would end in beatings. Joseph tells about hitting his own children. He was administering a spanking to his daughter when his son came to his sister's defense with a baseball bat. Joseph ended up physically punishing both of them. Joseph reports that he might be losing control. He said that "you can only push a guy so far before he snaps." He said that he is feeling dead and then threatened, "If a guy's dead already, if he's got nothing to lose, he can get very dangerous. And there's a few of them he might take with him when he goes." When questioned, Joseph said that he was just talking through his hat. But I'm very concerned. I think Joseph is headed towards a crisis and that it could easily become violent. I prescribed Prozac and made an appointment for Thursday.
Wednesday, July 31, 1996	11:30 am. Telephone call from Joseph Mazurka. Received a phone call from Joseph Mazurka. He canceled our appointment for tomorrow at 2 pm because he is going out of town. He reports that he is taking the Prozac, but that it isn't doing much of anything that he can tell. Made an appointment for 4 pm, Monday, August 5.
Monday, August 5, 1996	4 pm. Fourth Session with Joseph Mazurka. Joe Mazurka reported that he has been taking his medication the last few weeks (I actually first prescribed one week ago). He says that it has been working, that his body feels better and he hasn't been so "pissed off at everyone." But Joe has decided that he doesn't want to continue therapy. He feels the drugs are working, but I feel that even with a pharmacological approach, Joseph is struggling to keep his aggression under control. However, Joseph said that the reason that he has been coming is to appease his boss, who is now appeased. Joseph reports that he is still utilizing the services of prostitutes. He talked a bit about the sexual harassment complaint lodged against him. My prediction is that I'm not going to see Joe again until some form of crisis develops. 6 pm. Doodles of Joseph Mazurka. I had an opportunity to look at the doodles that Joseph Mazurka brought in today. They are quite twisted, and I'll make notes on each of them. But the thing that strikes me the most is that he must have known that I would react to them as twisted. And yet he brought them to me anyway, on the day where his stated goal was to get a clean bill of health from me. Is it self destructive behavior or a plea for help? The first drawing shows a grinning naked woman lying on her back "split eagle", a knife aimed at her genitalia, a laughing devil's head with sharp teeth as her pillow. Around her are three bar bells, a plane dropping bombs and two guns--a handgun firing, and a machine gun. The second drawing shows a maniacal figure in the center of the page. He has an erect penis, three knives sticking out of his head, strange scythes as hands and bombs for feet. Under his feet, more bombs are dropping away, while over his head is an arc of seven stars. In total, there are also seven bombs. The third drawing doesn't have a central focus like the other two drawings. Here the paper depicts four images of almost equal weight. On the top left is a curved scimitar with a pierced Cupid's heart as part of the handle. Next to it is a rock (?) with a giant foot coming out of it. The foot is crushing a car, Monty Python style. The car has an alligator's mouth for a hood. There is a figure with crosses for eyes, falling down out of the bottom of the car. He has clearly let go of a bow, falling with him. The figure, presumably, is the Cupid. It looks like three demon faces are still to be seen through the windows of the car. Out the back of the alligator car is a great cloud of exhaust, almost like a flower, filling up a quadrant of the composition.
Thursday, August 8, 1996	3:30 pm. Telephone Call from Carol Mazurka. I got a call from Joseph Mazurka's wife. She said that Joseph has been acting strangely lately--"shouting, screaming, talking crazy." It sounds like Joseph might be having a psychotic episode. Ms. Mazurka thought they could be the side effects of the drugs that I prescribed, but I told her that such symptoms really couldn't be caused by Prozac. She then told me that she suspects he might have been taking anabolic steroids at the gym, which could account for the psychotic behavior. When I asked to speak to Joseph, Ms. Mazurka spooked and begged me not to tell Joseph that she had called.
Monday, August 12, 1996	4 pm. Fifth Session with Joseph Mazurka. Joe came in and was agitated and restless. He didn't speak at all about his vow not to return to therapy, but came at his normal time as if nothing had changed. He couldn't sit still, pacing during much of the session and gesticulating excitedly as he spoke. His skin was unnaturally pale and he looked puffy around the face. He kept referring to his work at the gym in getting himself in shape--how he was weak before but now he is strong. Finally, near the end of the session, Joseph confirmed what Carol had told me--that he was taking anabolic steroids. I warned Joseph about the side effects of steroids, particularly liver failure and psychological harm, and obtained his promise to discontinue the injections. Joseph says that he has been enjoying himself more and, when questioned, rhapsodizing eloquently about the beauties of slasher films. He particularly likes the most graphic depictions of beheadings and shootings. Joe says that he is through taking shit from people. He said that since he can rip a person's throat out, that he shouldn't have to put up with petty annoyances from that person. His conflicts apparently have been limited to stare downs so far, but I'm afraid that it might escalate, especially if he doesn't stop taking steroids.
Monday, August 19, 1996	4 pm. Joseph Mazurka was a complete no show for our session. Didn't phone or leave a message with the service.
Thursday, August 22, 1996	5:30 pm. Telephone Call from Sgt. Tracy Keefe of the SFPD. I got a call from Sgt. Keefe regarding Joseph Mazurka. Apparently, on Sunday, August 18, he assaulted his wife, beating her up pretty badly. The kids weren't involved. He was arrested and taken into custody. This morning, he was released on bail, but Carol has applied for a restraining order. The police believed that drugs were involved in the incident, my guess is from psychotic behavior exhibited by Mazurka at the time. Apparently, Joe didn't keep his promise to stop taking the anabolic steroids.
Monday, August 26, 1996	4 pm. Sixth Session with Joseph Mazurka. I got as angry with Joseph during this session as I have ever been with any of my patients. I was really on the verge of losing my cool. Joseph is completely unwilling to accept any real blame or responsibility for his actions, even when they involve beating up his wife so severely as to send her to the hospital. His posture is that he is interested in a reconciliation mostly for financial reasons--it is expensive to finance two households. But he lets slip that he is really lonely without his family, sitting in a bar to pass the evenings. Even his usual enthusiasm for prostitutes is muted. Joseph claims that he had temporary insanity which made him lose control. Of course, he was still taking steroids when the fight occurred, after he had promised me that he would stop. Joe is willing to go through couples counseling if that would help. Since he can't contact Carol, because of the restraining order, he asked me to call her and plead his case. I told him that I wouldn't do anything other than be honest with Carol, which seemed to disappoint him. He's also interested in visiting his kids in an unsupervised outing. At the end of the session, he started to threaten Carol, when I suggested that there was a possibility Carol would press charges. Joseph categorically refused to come more often than once a week, so I made an appointment with him for next Tuesday at 10 am.
Thursday, August 29, 1996	1:30 pm. Telephone Conversation with Carol Mazurka. Honoring Joseph's request, I called Carol Mazurka at her home. Carol seems unwilling to consider a reconciliation at this time. She believes that it would be better for both her and for the kids if she separates from Joseph. She is glad for the fact that a precipitating event occurred which gave the relationship some clarity. She seemed genuinely afraid of Joseph, although strong. She threatened to kill him if he came around her. She said that she hates him and doesn't want to see him at all, even in court. She said that she might call me back but, as she warned me, I won't hold my breath.
Tuesday, September 3, 1996	10 am. Seventh Session with Joseph Mazurka. Joseph Mazurka is becoming increasingly agitated, out of control, and difficult to deal with. He is very angry with Carol for throwing him out of the house, and he is having elaborate revenge fantasies about her. He in no way accepts any responsibility for the circumstances which have led him to be sleeping in the fleabag hotel, as he puts it. He is mentioning suicide, but only in passing, threatening to take some of his co-workers and/or his wife with him when he decides to commit suicide. Then he backs off entirely and says that he is just blowing off steam. Later on, though, Joseph says that he is worried about what might happen if he is pressed too far--implying a violent outburst. Joseph's aggressive tendencies are further aggravated by the fact that he likes to shoot guns as a hobby and has a number in his possession. He counts reloading bullets (making new shells out of old ones) among his paltry list of hobbies. Joseph revealed that he doesn't have any real friends . Also disturbing, although he has stopped taking the steroids, he has also discontinued taking the Prozac. At my urging, he is considering restarting his medication.
Monday, September 9, 1996	4 pm. Eighth Session with Joseph Mazurka. Joseph came to the session today obviously high on some central nervous system stimulant. His eyes were dilated, he couldn't sit still, his speech was hurried and disorganized, his anti-social ramblings were more extreme if anything. He was quick to anger and appeared to have psychomotor agitation. He was sweating profusely. He claimed that he was taking over the counter diet pills, but I don't believe it--this was not a reaction to a caffeine based preparation. My guess is that he is taking dextroamphetamine, methylphenidate, methamphetamine or phenmetrazine. Although it is possible that it is a cocaine reaction, I would tend to doubt it. I'm not sure whether ice--crystallized methamphetamine--has hit the black market in San Francisco, but at Columbia in New York it was prevalent. Joseph strikes me like many of the ice abusers I saw in the clinic there. Despite the restraining order, Joseph has apparently been haunting his wife's place, trying to watch her comings and goings. The house has appeared empty. He threatens her with a kidnapping charge if she leaves without notice and takes the kids. In his new drug-induced euphoria, Joseph feels like he can change everything that's wrong with his life--his failing marriage, his job, even his department and software scheduling delays. He went in and told his boss about his ideas and I wouldn't be surprised if his boss was somewhat disturbed by what he had heard. Joseph now isn't sorry about the beating that he administered to his wife. He professed a belief that a man is entitled to beat his wife and while he regrets the incident, it was partly Carol's fault because she knows how to push his buttons. Joseph also was making some pretty wild statements about trying to overthrow the government through violence. He even made semi-approving references to the Oklahoma City bombing and to Adolph Hitler. I told Joseph that he needed to immediately stop taking any drugs and to try to begin to follow my advice, but I'm not sure that it will effect any change. Joseph is afraid of being labeled a sociopath in his paperwork, and that may be the only reason why he continues coming to these sessions. Except that I believe that he knows, deep down, that he is in desperate need of help.
Monday, September 16, 1996	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.
Thursday, September 19, 1996	Letter to Bill Bennett respecting Joseph Mazurka. I spoke in part about Joseph Mazurka in my letter to Bill Bennett.
Monday, September 23, 1996	4 pm. Tenth Session with Joseph Mazurka. What am I going to do with this guy? I threatened to have him committed and he just lost it--I'm afraid that he would get out of confinement and kill me, I really am. If I'm honest with myself, I know that I would have him committed if not for fears for my own safety. If Joseph was an elderly lady exhibiting the same symptoms, she would be at Bellevue, or whatever the San Francisco equivalent is (SF General?), so fast... I'm not sure how much good I can do for a patient that I'm terrified of, or to be honest, that I loathe as much as I do Joe. What a terrible person at a fundamental level! When I think of the mentally ill, I'm drawn to those people who are basically good but who are wrestling with psychological or neurological deficits. I'm not considering those who are genuinely evil. Joseph's illness is on top of his evil qualities, not causing his wickedness. Should he be institutionalized? My pick would be jailed. Was he just blowing off steam as he insisted or is it possible he's going to act on some of his threats? If I had him committed, he would be away from amphetamines for 3 days, just long enough for him to appear completely lucid during the commitment hearing. I would appear before the court and testify that, in my professional opinion, Joseph is a danger to himself and to others. Joseph would be completely in control and would make an effective counter. Joseph would be released and I would be in mortal danger without ever having made a difference. An institution would merely be a holding place for Joseph--he'll never get the treatment there that he so desperately needs. And even if completely cured, he would still be an evil and malevolent force in the world. I'm not sure if he is ever coming back and I have to admit I feel some relief. But could I do anything more? Do I owe a duty to society at large to do more? I don't have the answers and I hope I never have cause to revisit the questions.
Monday, September 30, 1996	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.
Monday, October 7, 1996	10 am. Eleventh Session with Joseph Mazurka. Oh god! I think that Joseph raped Phylis! I'm not sure but he describes a sleazy bar, a woman named Martha who looked better without her make-up than with it, a man who didn't know her name but insisted that she leave with him (Phylis' husband Jack, who probably is now in a hospital, wouldn't have known the name 'Martha'). It has to be Phylis, doesn't it? I certainly hope not. I'm listening to Joseph describe this rape and he's trying to make it sound like he's being the perfect gentleman. Somehow I doubt that will be Phylis' take on the events of last Thursday. I can't believe that I'm treating this monster! At the end of the session, I actually begged him to keep coming for therapy. I know I'd feel less responsible for his actions if he just split and never came to another session. He keeps coming and I feel responsible for whatever he does on the outside. He might end up killing someone. If I read about it in the papers, it would be surrounded by a nice unreal gauzy haze that would lessen its emotional impact on me. But if the police dig up his wife and children from their backyard, I'm going to be emotionally crippled as a result. Am I in some way responsible for what happened to Phylis? Would Joseph have been there that night if I had had the courage to order his commitment? In the history of psychotherapy, has it ever happened that one patient raped another patient? How do I treat their conflicting needs? Should I counsel Phylis to report Joseph to the police? I've got to call her immediately. Other items that Joseph discussed included using his sniper's scope on his rifle to peer into his neighbors' windows and his denial of any criminal wrongdoing respecting his wife and children.
Friday, October 11, 1996	I received an addition to Joseph's personnel file dated September 5, 1996. A couple of interoffice memos have made their way into his record--one from his supervisor who was upset when Joseph came into his office ranting about his plans for improvements and the other the response from higher management. I remember Joseph talking about having a conversation with his boss about some of his suggested improvements during his session at the time and I wondered then whether there were going to be any repercussions. Higher management is going to overlook this incident, although the memos did end up in Mazurka's personnel file.
Monday, October 14, 1996	8:20 am. Joseph actually called me to cancel his appointment. I was surprised by his consideration--usually he just doesn't show up. But when I tried to ask him some questions about how the medication was working and what was going on in his life, he just insisted that he had pressing engagements and waved away my questions. I think that Joseph doesn't believe that therapy has any real benefit for him, and the irony is that I've never met a patient who is more in need of extensive therapeutic help. 12 pm. Sixth Session with Phylis Birch. I heard Phylis' story of her encounter with Joseph Mazurka and it was as I feared. When Phylis was playing Martha and was surprised by her husband, Joseph viciously beat him and then, while Phylis was in shock after watching her husband reduced to bloody unconsciousness, tried to rape her. Jack suffered substantial damage including broken ribs, broken nose, broken right leg, a missing tooth, and internal injuries. Phylis still seems a little numb. I feel that she really needs to talk further, but she is trying to be strong for Jack. Of course she feels guilty for having brought this upon Jack, and I don't think that she's had the opportunity to come to terms with her own feelings about the events of that Thursday night. Right now, most of what she is feeling is fear. She got a page from Jack about half way through our session and had to run off to minister to his needs. I didn't tell Phylis that I'm treating Joseph Mazurka and, of course, I haven't told Mazurka that I'm treating Phylis. I feel by concealing his identity I'm protecting Mazurka in some way and I can barely stand that thought. He's such an awful human that I don't think therapy is really likely to cure him. I'm glad he canceled his session today because I don't think that I would have been able to face him after having listened to the pain he has brought upon poor Phylis and her innocent husband.
Monday, October 21, 1996	4 pm. Twelfth Session with Joseph Mazurka. Joseph continues to display absolutely no remorse for his assault on Jack and his rape of Phylis. He believes that his actions were completely justified--in fact, he sees himself as the hero of the story. He even spoke approvingly of rape, although he said that he was too old. Then he launched into an outrageously racist diatribe against homosexuals, blacks and interracial marriages--a "they're going to overrun us" type argument. He talked about how he was allied with a group of white men who were going to do something about all the ills they perceive--some dramatic, "front page" type of gesture. I'm afraid that I completely lost it. I just couldn't listen to it anymore and I lost my cool. I told Joseph that I thought he was a pathetic loser trying to compensate for his own inadequacies by abusing those around him. And I told him that therapy wasn't going to work at all as he is completely uninterested in turning around his life, instead wallowing in paranoid misogynistic, racist fantasies. I told him that I thought he was just trying to indulge every evil impulse he could come up with. Joseph was a little taken aback--he thinks of me as completely spineless, I'm sure. But actually my outburst was probably therapeutically valuable. For anything to work with Joseph, it will have to jar him out of his standard thought patterns. Joseph ended by asking me for a favor--to hold off on my suspicions regarding his activity with his group of shooting range, bar types. He said that maybe what they are planning isn't such a bad thing after all. What are the chances that what he has in mind is a random act of kindness?
Monday, November 18, 1996	10 am. Thirteenth Session with Joseph Mazurka. Joe came into my office at his "usual" time, although he didn't have a scheduled appointment. Frankly, I was quite surprised to see him. He started the session somewhat menacingly and, to be honest, I find him quite scary. He accused me of tipping off somebody at SII about his terrorist leanings which I of course denied. Apparently, he is being recruited by some actual terrorists. His ramblings before were just those of a braggart, but now he seems to have a direction. Now I believe that he has actually hooked up with some bad people who have some technical sophistication. Joseph is stupid enough to be led astray--he has lost any ability to distinguish desirable from undesirable consequences. I can imagine him planting an Oklahoma Federal Building kind of bomb--killing children and whoever else might be there. He just has no perspective on his actions and he is increasingly despondent over losing his family. I pointed out to Joseph that he might be desired as a suicide bomber or something, but Joseph just brushed me aside. I am increasingly blunt in talking to Joseph, but it seems to faze him not a whit. Nothing that Joseph said during the session though would constitute the kind of immediate threat to others which would justify my breaking the session's confidentiality. He is scaring people at work, too. I suggested that Joseph might get fired, but he said that nobody there would dare--they are all too frightened of him. He did admit though that he is on auto-pilot there. He is definitely sinking further into the mire and there doesn't seem to be a damn thing I can do about it. He wanted me to give him a prescription for marijuana, a request which I declined. He also thinks that he has seen Phylis at work. I'm concerned that he might confront her there and I would like to think of a way to prepare Phylis for that without betraying either Joseph or Phylis.
Monday, November 25, 1996	10 am. Fourteenth Session with Joseph Mazurka. Joseph made a surprise appearance at his "usual" time. He has apparently really gotten himself in deep with a gang of terrorists and he doesn't see any way out, even if he was so inclined. He is having severe money problems--the IRS has garnished his wages and he apparently borrowed money from loan sharks--and he sees the terrorist group as his only escape. The terrorists promised that they would try to find Carol and the kids. Apparently they have sophisticated computer skills allowing them access to a group of secure databases, although I sense Mazurka could be easily fooled with some fancy graphics and a few phony records. He thinks if he can just talk to Carol face to face, he can intimidate her into coming back. It isn't as if he particularly cares about Carol or the kids. Rather, it's as if they left on their terms and somehow he lost face or got cheated. Actually, the terrorists sound like they are planning a purely criminal endeavor--for money rather than principles or idealism. With the garnishment of Joseph's wages, Joseph doesn't sound very interested in continuing to go to work at SII. So Joseph has lost his wife and kids, his house, probably his job. He is in trouble with the IRS and with loan sharks and has no money. And he is hooked up with some terrorist outfit who'll probably end up taking his life. Still, Joseph doesn't see that he has any internally created problems. Everything is someone else's fault. He is totally unwilling to try to cause any changes in his life, or even to take any of the medication which I've prescribed. Given that he is determined to go straight to Hell, I told Joseph that there wasn't much to talk about--other than what was the quickest path. I told Joseph that if he was determined to destroy himself, that he could leave me out of it. Joseph interpreted this as my throwing him out of our sessions. I left the door open if he ever thought that he might be interested in making some changes and I asked him why he was coming to the sessions in the first place. He said that if he just disappeared, he'd like someone to know what had happened to him. At the end of the session, he leaned over to me and said, "Watch out for the Irishman; he's a killer." I hope I don't read about Joseph in the newspaper or hear about his body washed up somewhere. I have no idea what I'd do or who I'd contact with what information I've got.
Tuesday, December 3, 1996	1:30 pm. Conversation with FBI Special Agent John Kline respecting Joseph Mazurka. I was surprised this afternoon with a visit from the FBI. Actually, I have been half expecting it after Joseph's revelations during his last session. Joseph and his cronies stole sensitive computer data and then tried to extort money from the government by selling it back. The government went along and traced the money back to Joseph. Now he is in deep trouble, not only from the FBI but also from his compatriots, who must realize that Joseph is the only link between the money and them. Agent Kline convinced me that it would be in Joseph's best interests for me to reveal what I knew about the whole affair, which wasn't much. I hope they find him in time.
Wednesday, December 18, 1996	Joseph Mazurka is dead. Completely by accident, I was going through the paper and there, on an inside page, was a small article about a San Francisco man who was shot to death and found in a dumpster. It was Joseph. Such a dismal end, to be unceremoniously dumped in the trash and then to evoke only a slight mention in the press. Inconsequential I know, but that's what I thought about first. The reality though is that I totally failed Joseph. He came to me for help and, although he was a difficult patient to be sure, I ended up unable to give it to him. Under my care, he became dependent on illegal drugs, lost his family and his home, went into debt, became paranoid and finally turned to crime. Quite a track record. I always knew that I might lose a patient someday. I expected it to be a suicide, I guess. But here is the reality. Joseph is dead and no matter what I do now I can't change that. Was it the Irishman that he warned me about? The FBI agent was right. Joseph was the link between the gang and the FBI. If the FBI had captured Joseph, and they were sure to eventually, Joseph would have rolled over on the group. They knew it, but I don't think Joseph ever did figure out how much more valuable he was to them dead. I think I even told him that was a possibility, but my words meant nothing to Joseph then. Do I have to worry too? Is there a possibility that I'm in danger because of a fear of what Joseph might have told me? Is this unfounded paranoia? I guess I hope that my next patient isn't an Irishman with a penchant for firearms. Gallows humor. Joseph was a son-of-a-bitch, that's for sure. I'm not going to try to ennoble him because he was murdered. He was a very scary guy and seemed actually capable of causing some very real harm to a lot of people. I can't forget that. I was half expecting Joseph to be the crazed gunman in some horrible repeat of the 101 California shootings. I think Joseph saw himself like that too sometimes. But I think some part of Joseph wanted to avoid that fate. I adopted a fairly harsh tone with Joseph, especially towards some of the later sessions. I really believed that it was the best way to get through to him--he never seemed offended and actually seemed to respect me more when I wouldn't put up with his shit. But perhaps I was wrong. Maybe I should have been more nurturing. Who am I kidding? Nurturing? I should have had him committed. While he was abusing amphetamines and was going through his psychotic episodes, he was clearly committable. If I'm honest with myself, I know that I would have committed him, but I was scared of what he would do when he got out. That was it. I was scared for my personal safety. And now he is dead. It's true that he's not dead directly because of his mental aberrations--he did knowingly decide to join a criminal endeavor with a group of people whom he knew were killers--but I might have been able to save him if I had had more personal courage. The fact that he kept coming to me was a clue that he knew that he needed the help, however much he protested to the contrary. And the truth is that I just didn't or couldn't help him. Maybe another psychiatrist could have. Maybe I do have to accept some sort of ultimate blame for the path that Joseph took. I failed him because I had given up trying to save him. It's late and I'm exhausted. Joseph's been murdered. That has to become part of my new reality somehow.

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Joseph Mazurka's Patient File

Charles Balis' Notes by Patient