Session Three

Patient X

Clinical History of Patient X

Age: 55

Sex: Male

Race / Ethnicity: White American

Allergies: Possible paradoxical reaction to Buproprion

Referring Psychiatrist: Jorge Sánchez Cruz, MD

Medications: Atacand 16 mg. QD

                    Norvasc 2.5 mg. at HS

                     Lexapro 20 mg. QD

                     Klonopin 1 mg. TID

                     Dalmane 30 mg. at HS

Chief Complaint: “They think I’m worrying too much about Schubert.”

Clinical Notes:  The patient evidenced hostility from the moment he entered the office.

“And the first problem I have with you,” he said, pointing his finger directly at me “is your ridiculous name.   Weinstein  indeed,” he snorted.

It was evident that he had started a negative transference, thus I was careful to be non-threatening.

“Perhaps you could tell me, X, what issue you have with my name….”

“Have you no German, Sir?  Or even any curiosity about your surname?  You must know what it means!”

His nostrils were flared.

“Perhaps you could tell me….”

“ Of course I could tell you,” he snapped.  “There’s no perhaps about it.  Wein is exactly what you’d think—an alcoholic beverage produced by fermenting grapes.   Stein—a vessel used to consume beer.   Thus, you are walking around advertising yourself as a moron who drinks wine from a beer vessel.  And it is to you that I am to entrust my psyche?”

I decided to allow him to pursue this topic.

“And what would you like to call me?”

“Well, what’s your tipple?”

“I beg your pardon?”

“Your drink, Doctor—what do you drink?”

“I have an occasional glass of wine, socially,” I said.

“I detest social drinking,” he snarled.  “A binge, yes.  Constant inebriation—much to recommend it.  But social drinking is, in a word, for wimps.  However, since it’s wine you ‘socially’ drink, your name will now be Weinkelchglas.  Not bad, actually.  Though you might change to beer, in which case you could be the somewhat easier Bierstein.   Your choice, Sir.”

“Let us now,” I said, trying to control my temper (my own negative counter-transference had begun) “return to the reason for your visit here, today.  Dr. Sánchez notes that you seem preoccupied with Schubert.”

“Let’s get one thing straight, Doctor,” said X, leaning across my desk.  “I do not like the word seem.  It’s a word that, well, only a social drinker would use. I am, or I am not.  I do not seem.  And yes, I’m certainly worried about Schubert.  There’s certainly good reason to be….”

“Schubert—the German composer?”

“AUSTRIAN, AND MORE, VIENNESE!  Known in German, Sir, as Wein—Dr. Weinkelchglas.  God’s blood, have you NO education?”

“Harvard Medical School, class of ’83,” I said.

“Not an unknown school,” he acknowledged.  “Well, we know you have no German.  Greek?”

“No,” I said.

“Latin?”

“Nor that,” I returned.

“You are, then, merely schooled.  Educated, much less learned, you are not.”

“You change topics frequently,” I said.  “Could we return to your preoccupation with Schubert, the, err, Viennese composer?”

It was then he cracked.  Tears streamed down his face, twisted with anguish. 

“ Drei sonnen sah ich am Himmel stehn.  I saw three suns stand in the sky. Now two are gone.  Ging nur die dritt’ erst hinterdrein!  Would that the third might follow!  I would feel better in the darkness!”

Notes:  Poor impulse control, evident poor self image (as evidenced by his need to seem superior) and probable psychosis.  Will add an antipsychotic, Haldol, 5 mg. TID to medication regimen.