March 27, 1991

The patient was seen for 50 minutes for individual therapy. Although he was initially not talkative, after about ten minutes he did volunteer more information. He had a difficult two weeks. Spring vacation initially went well, but on Friday night his brother was in a serious automobile accident. Although is brother will be alright, the closeness of the situation left the patient feeling “irritated.” We explored this more and he talked about the possibility that his brother could have been killed. Several things have happened at school that have also been difficult for him. The base guitar that he uses for concerts was stolen over spring vacation, the friend who he had previously worked as a disc jockey with and had a falling out with has found another friend to start a business again and supposedly was planning on circulating a pamphlet explaining why he could no longer work with the patient and talking about the patient having mental problems and being hospitalized. The patient has not told his parents about this. He talked about his feelings of anger towards the friend and what he wished he could do, while at the same time feeling that at some level there was nothing he could do about people's reaction to him. He felt at times friends avoid him even though they tell him how much they do not like the behavior of the other person. He admitted he had some suicidal thoughts over the weekend but no specific plans and then thought to himself, “I'm not going to let this get to me.” He has been spending a lot of time with his girlfriend, who remains supportive. He continues on nortriptyline 100 mg at night. He is sleeping adequately throughout the night and does not want to increase the medication at this point. I agreed not to for at least two more weeks. He was rescheduled at the next time he can get over here in two weeks.

The Cheese Man, M.D.