The following is an excerpt from the notes of Dr. Allen Fowlurgen, noted psychiatrist specializing in cases of extreme disorders of habitual self-abuse. The patient is a 45 year old white male suffering from extreme nail biting and hair pulling. His name is Patrick Quincy and resides in Chicago. Session 33: Patrick seems calmer than normal today. The patient has worn the same ball cap to the past six sessions but is not wearing the jacket he has worn since his first session. Also, visibly notable, are the bandages he now uses on every finger on his left hand. Patient has not shown a tendency for biting his right hand fingernails. Also noted are the burn marks on patient's neck located below cheek line on right side. One mark is approximately two inches in length and smaller marks follow in a downward pattern up to top of shirt collar. Patient does not seem to be in any physical distress from new marks and seems to be making attempts at hiding his distress by rubbing left side of neck to distract from marks on right side. Patient also seems calmer and in control beyond what can be considered the norm for him. The following is the dialogue between myself and patient as recorded from the audio recording for session 33:
Dr. Fowlurgen - "And how are you today Patrick?"
Patrick - "I am in control."
Dr. Fowlurgen - "Control?"
Patrick - "Yes, of everything."
Dr. Fowlurgen - "I didn't think that would be possible Patrick."
Patrick - "Of course you wouldn't. You're not in control."
Dr. Fowlurgen - "That would be true. I don't see the possibility of such a thing. What's your secret?"
Patrick - "That's a dangerous question doctor."
Dr. Fowlurgen - "I noticed you're not wearing the Cub's jacket this morning."
Patrick - "We really don't know where we end and the ice age begins, do we doctor?"
Dr. Fowlurgen - "Patrick, do you want to get better? It's important to really think about my questions."
Patrick - "I'm here. I know when time stops and time starts."
Dr. Fowlurgen - "Do you have another appointment today Patrick?"
Patrick - "Yeah, an appointment with your wife."
Dr. Fowlurgen - "Patrick, why do you want to insult me. Do you blame me for what happened to your jacket?"
Patrick - "Your wife thinks so."
Dr. Fowlurgen - "I really want to help you but you're being very offensive."
Patrick - "That's funny. Your wife said the same thing about your b.o. (laughter) Ha ha b.o."
Dr. Fowlurgen - "Patrick, my wife passed away two years ago. You know this."
Patrick - "Probably from you b.o." (more laughter)
Dr. Fowlurgen - "Do you blame me for what's happened with your jacket?"
Patrick - "We are just vessels doctor. I know when time starts and time stops."
Dr. Fowlurgen - "Were you running late this morning Patrick? Is that why you forgot your jacket."
Patrick - "No. Your momma is so fat she wore it."
Dr. Fowlurgen - "Patrick, you have to take this seriously. I want to ask you about the marks on your neck. Did someone burn you Patrick?"
Patrick - "No!!!! Time is the enemy and you're no Hitler."
Dr. Fowlurgen - "Was it someone close to you?"
Patrick - "Where do we go from here now that all of the children have gone?"
Dr. Fowlurgen - "Patrick, did you cause those marks on your neck? Are you afraid of your right hand?"
Patrick - "When will you shut up?!! I don't like this place anymore!! "
Patient began to cry and eventually calmed down. I am afraid he has triggered something deeply from his memories of a childhood trauma. The referrals to my wife and mother may indicate patient was a witness to a severe traumatic event involving his mother or sister or some other female important to him in early childhood. I felt it was best to end the session and transfer him to West Side clinic for closer observation. The missing jacket seems very relevant to another event in his life that was based upon a meeting that ended something. His referrals to time during this session are similar to session 32 and 31. Something seems to be approaching as in an anniversary or other significant date. If I can locate the specifics it may determine an actual triggering point for nail biting and hair pulling. Patrick may be realizing this himself but is afraid to go in a different direction or even fear being cured. It may be the only bond he has to the tragic loss he suffered. End of session 33.
Dr. Fowlurgen - "And how are you today Patrick?"
Patrick - "I am in control."
Dr. Fowlurgen - "Control?"
Patrick - "Yes, of everything."
Dr. Fowlurgen - "I didn't think that would be possible Patrick."
Patrick - "Of course you wouldn't. You're not in control."
Dr. Fowlurgen - "That would be true. I don't see the possibility of such a thing. What's your secret?"
Patrick - "That's a dangerous question doctor."
Dr. Fowlurgen - "I noticed you're not wearing the Cub's jacket this morning."
Patrick - "We really don't know where we end and the ice age begins, do we doctor?"
Dr. Fowlurgen - "Patrick, do you want to get better? It's important to really think about my questions."
Patrick - "I'm here. I know when time stops and time starts."
Dr. Fowlurgen - "Do you have another appointment today Patrick?"
Patrick - "Yeah, an appointment with your wife."
Dr. Fowlurgen - "Patrick, why do you want to insult me. Do you blame me for what happened to your jacket?"
Patrick - "Your wife thinks so."
Dr. Fowlurgen - "I really want to help you but you're being very offensive."
Patrick - "That's funny. Your wife said the same thing about your b.o. (laughter) Ha ha b.o."
Dr. Fowlurgen - "Patrick, my wife passed away two years ago. You know this."
Patrick - "Probably from you b.o." (more laughter)
Dr. Fowlurgen - "Do you blame me for what's happened with your jacket?"
Patrick - "We are just vessels doctor. I know when time starts and time stops."
Dr. Fowlurgen - "Were you running late this morning Patrick? Is that why you forgot your jacket."
Patrick - "No. Your momma is so fat she wore it."
Dr. Fowlurgen - "Patrick, you have to take this seriously. I want to ask you about the marks on your neck. Did someone burn you Patrick?"
Patrick - "No!!!! Time is the enemy and you're no Hitler."
Dr. Fowlurgen - "Was it someone close to you?"
Patrick - "Where do we go from here now that all of the children have gone?"
Dr. Fowlurgen - "Patrick, did you cause those marks on your neck? Are you afraid of your right hand?"
Patrick - "When will you shut up?!! I don't like this place anymore!! "
Patient began to cry and eventually calmed down. I am afraid he has triggered something deeply from his memories of a childhood trauma. The referrals to my wife and mother may indicate patient was a witness to a severe traumatic event involving his mother or sister or some other female important to him in early childhood. I felt it was best to end the session and transfer him to West Side clinic for closer observation. The missing jacket seems very relevant to another event in his life that was based upon a meeting that ended something. His referrals to time during this session are similar to session 32 and 31. Something seems to be approaching as in an anniversary or other significant date. If I can locate the specifics it may determine an actual triggering point for nail biting and hair pulling. Patrick may be realizing this himself but is afraid to go in a different direction or even fear being cured. It may be the only bond he has to the tragic loss he suffered. End of session 33.
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