by Sareen Equality

August 19, 1997
Dear Majka,

I’ve been using the old typewriter again. I’m just now realizing that it was the only toy I ever played with, the only friend I ever had. Did you know that? The cracked, white keys feel luxurious under my skin. Sometimes when I press down hard enough, I can bleed. I took it out of the study though, once Dr. Caplan and I began seeing each other.  He was attracted to the blue patterned loveseat and fox fur carpet. I told him that was your favorite carpet. But he could never appreciate it as much as you. 

            I now write in the basement. It’s darker and damp. And the darkness is so damn beautiful. 

 ~ Alek

August 24, 1997
Dear Majka,

Before I confess, it was not my idea. Dr. Caplan wanted me to do it. Actually, he forced me to do it. Every time he talks, his chalky beard shakes. I think it’s infested with maggots and I did not want maggots falling onto your favorite carpet. But it kept shaking because he wouldn't stop talking and so I agreed just to cut the visit short. 
Confession: I went outside. 
Did you know that all the houses in our neighborhood are large too. I walked past a willow tree. And even further past the last house on Grain Street. I would’ve stopped there but Caplan said to “experiment with experiencing the world and what it has to offer since I could never as a child,” I needed to shop because shopping, food, and music are universal. At least, that’s what I could make out through his fairy voice. And I know you said stay away from the fairies but he was the only doctor who made house calls. I understand now, that you kept me isolated for a reason. You truly believed that if I went around other people that I would tell but thinking back on it now, I probably would’ve never told. I couldn’t tell. I adored you too much.
I’ve never spent the money you left behind before today, except on Dr. Caplan but that’s the government's fault. You did say you hated the capitalist country America has grown into. But, I figured you’d be more livid if it went to waste. I didn’t keep count of how many stores I went into, I was never good with numbers. The ladies at the stores helped me because I guess I looked pretty lost. Or pretty foreign. Or just pretty. While they were helping me, all they could talk about were my eyes and my cheeks. What they didn’t understand was that these were burn scars and not  “rosey”. But I did say these eyes were from your genetic pool. That got me a couple of numbers. You did always say that I was a lady killer. I mean, I guess that’s why you’re dead huh. I didn’t contact any of them partly because you never really liked me talking to girls, or anyone for that matter. 

~ Alek

Progress Note
Client’s Name: Alek Marušić
DOB: 01.01.1977
Session Date: 08.25.1997

Intervention 

This appointment was held in Alek’s household, as previous sessions were held as well.

• House is extremely tidy, as usual

• Extremely thick layer of dust everywhere 

• Light rotten order throughout home

• Alek’s hair is wet, possibly just took a shower

↓

Nothing unusual to note

Alek reported to me that he was able to go outside today and spend some of the inheritance “Majka” left behind. He seemed a little too eager to let me know about his excursions but extremely vague when I tried to get more details out of him. 

Session Notes & Summary

This session focused on Treatment Plan 1 (introducing the idea of trying new medication for Alek’s manic depression and anxiety disorder). I attempted to continue the discussion of his venture out.  

• Disliked his attention from women

He believed that he developed a spending problem because he spent over a hundred dollars on new clothes. He also informed me he was wearing the new clothes he bought. These clothes were certainly clothes he had worn at a previous session we had. I had pondered on the idea that maybe he bought the exact same clothes because they were very clean, but the shirt had the exact same rip on the left sleeve. I attempted to question him on this and there was no further conversation after. 

• Refused to talk for the rest of the session → common

Patients Progress Towards Treatment goal(s): 

 Medication is a preferred method to ameliorate Alek’s conditions. Though, with Alek being over eighteen years of age, he must consent to being monitored to ensure his consumption of medication. Consent has not been giving. Alek has not shown signs of being a danger to himself or others and his conditions have not worsened. He also hasn’t shown great signs of improvement in his conditions. Due to his severe general anxiety, he will continue to have at home sessions, twice a week until further notice. 

Signature: Richard Caplan                          Date: 08.25.1997

September 2, 1997
Dear Majka,

“Hair as black as Satan’s serpent.” You would  always say that to me. “Eyes as icy as the devil’s heart.” That would come right after. I’m replaying those moments. You know those moments. Those moments…when you would have me strip down, until I was naked. You’d examine every inch of my body. Cut at my arms because they were too bony. Slice at my ribs because I was too skinny. Rip out my hair because it was too…too…black. Sometimes you’d stab at my knees because I was too lanky. Sorry, I’m chuckling now because - ha - I remember when my hair became too thin because of the tearing. It’s thinner now. You were so angry that you had nothing to grip at anymore. But, I loved your grip. The vision of your nails, always painted that mustard yellow, is something I long to see. Because right now I’m stuck in the loop of your “I wish you were never born”s  and “You ruined my life”s. Your words scared the most and the pain made me feel better. And right now, the feeling of my blood running down my face and skin filling up the underneath of my nails is what allows me to continue my life. 
I can’t forget your grip and your fingernails. I can’t forget your short dry coughs and meth breath. I can’t forget. I can’t forget. I can’t forget. But who could forget their mother. 

~Alek

Progress Note
Client’s Name: Alek Marušić
DOB: 01.01.1977
Session Date: 09.03.1997

Intervention:

Alek showed up to the door with many abrasions. 

• Face had moderate wounds → deep scratches 

• Arms and legs had minor wounds → light scratches & scabs

On our way to the study, his limp was noticeable. Some of the wounds on his face were covered in white bandages dampened with blood. He informed me that he fell down the stairs. 

Session Notes & Summary

After seeing his injuries, I tried to focus more on Alek’s fall down the stairs. He said he was on his way to make himself food. Getting Alek to begin to eat normally has been an extremely long process since we began meeting. This could be a big step forward in Alek’s progression. Though, I stuck to discussing the fall. 

• He felt intense nausea from not eating for a bit → excuse, forgetfulness

• Hunger was so intense he fell down the stairs

On my first and only tour of the house, I did previously note that Alek’s stairs were old and cracked. Falling down them would not be surprising, but the damage is too intense. 

I moved on to the topic of Treatment Plan 1 (introducing medication for his manic depression and paranoia). He refuses to consent to be monitored while taking medication. 

• Hospitalization was brought out because of his injuries

The last thing he stated was “When Majka comes back, she’ll be able to help me.” 

• Silence for the remaining time 

The lack of communication and cooperation has started to increase throughout our sessions. This is incredibly concerning.  

Patients Progress Towards Treatment goal:

Still no progress on an agreement of consuming medication. There is suspicion of being a danger to himself. This will be investigated. If Alek’s state of mind continues to visibly deteriorate, he will be moved back into inpatient treatment.

Signature: Richard Caplan                          Date: 09.03.1997

September 19, 1997

Dear Mom, 

I met a girl. I know you never liked me talking to girls but Dr. Caplan told me not to care about what you think because you're gone but…. So, I met a girl. I had been walking around for hours. She asked me if I was lost and I said no. She asked me if I was cold and I said yes. She then bought me a hot chocolate and tea for herself at  the coffee shop on 9th Street. I liked that. She was a tea kind of girl and didn’t feel weird about buying a  man a drink. 

She had an unconventional type of beauty as well. Her hair was almost white while being very curly.  She had too many freckles. When I stared at them too long they began to move like ants. Tiny, tiny ants, crawling on her face. I asked if I could call her Angora because of the white fur on Angora kitties. She laughed then told me she has Mary Antoinette Syndrome. Apparently she developed it when she was fourteen during the Romanian War. She, along with her two siblings, were kidnapped and tortured because her parents were believed to be communist spies. It went on for months. She was the only one who survived it. After she noticed my face didn't change, she laughed and said I could call her Mariana. It meant bitter grace. I thought it was beautifully sad. It reminded me of you.

~Alek

Progress Note
Client’s Name: Alek Marušić
DOB: 01.01.1977
Session Date:09.20.1997

Intervention:

Alek looked very content today. He showed up to the door nearly smiling. 

• Wounds from the stair fall have finally healed or scarred over

• Deep wound on face (previously infected) looked clean 

• No fresh wounds present

• House is very clean → layer of dust keeps growing 

Him taking care of his wounds is a big step forward. He claims to have gone out, again, as well as claiming to have met someone by the name of Mariana. He talked very highly of this woman, almost how he talked about his mother. 

• Concerning 

• The prolonging of this has a negative outlook

Session Notes & Summary:

I asked further about his new friend. He repeated the exact same thing over again. Her name is Mariana, she’s tortured, bitterly graceful and reminds him of his Mom. This phrase was repeated over 20 times. I am suspicious of his reality when it comes to her.

• relationship unsafe for both parties

• Lack of concrete information on Mariana → real or hallucination?

We focused on Treatment Plan 1 (trying out medication for manic depression and anxiety) and Treatment Plan 2 (inpatient). During the investigation of Alek’s injuries, there was not enough significant proof that he had done this to himself. 

• Nails were too short → though he is not a nail biter

• No dangerous objects → these were removed two years back at his first hospitalization

• Reluctance of medication but suddenly agreed to the possibility

Patients progress towards treatment goal(s):

Treatment Plan 1 will be able to progress. Alek has signed the consent forms and he will be receiving medication starting September 22 of this year. Treatment Plan 2 (inpatient) doesn’t seem possible without the evidence present but progression is being made. 

Next session we will address the connection between Mariana and his Mom. We also will focus specifically on Mariana and how she impacts his life and growth. 

Signature: Richard Caplan                          Date:09.20.1997

September 26, 1997
Dear Mama,

I know my last letter may have seemed like I was saying I didn’t need you anymore. At least, that’s what Dr. Caplan suggested. I don’t think that’s true but I do understand that you will never let me go. That you will never let me be free. That, when you took your own life in front of my own eyes, you did it with the intention of keeping me trapped in this house forever. You wanted me to wait forever and ever and ever on edge for your return. Have my cries, and screams, and pleads go unheard - my throat shattering from the constant strain. So, I have to set my own self free. 

Now that I processed what I wrote, I think what I’m saying is….that I don’t need you….anymore. And, and, and, and  I’m saying this because you can’t come back. You can’t touch me anymore but more importantly you can’t utter those words. 

D-D-Demon

I-I-I Hate You

E-E- Evil

DIE.

Because you’re fucking dead. And the only person that can take my life now, is me. 

~Alek

TO: jean_green@topangapysch.org

FROM: richard_capalan@topangapsych.org

DATE: December 12, 1997

SUBJECT: Hospitalizing Alek Marušić

 Good Afternoon Jean,

I was right about my original assumption. Alek has been experiencing unnerving amounts of manic episodes. The woman that he mentioned before, Mariana, is a hallucination. This session, I was greeted at the door by him and Mariana, though Mariana was not there. He insisted that she was right next to him and that she was just “short” but I was still unable to see her. Instead of forcing this, I decided to evaluate what was going on. 

During this session, he’s been showing signs of intense aggression and happiness. The aggression ranges from screaming at me to address Mariana to shredding up the rug in the office.

His brain created the illusion of Mariana to compensate for the loss of his original keeper, his mother. His perception of reality is extremely off and his manic episodes now have developed into moderate to severe levels of schizophrenia. Please alert your staff to immediately prepare an emergency bed, I will be escorting him to Topang Psych Ward once the ambulan-

December 29, 1997
Dear Astrid, 

Hello Majka. I-I-I remember when you used to always get mad when I didn’t call you that. That was the only Croatian word that you ever taught me. You probably never got around to teaching more than that because you’d rather teach me that  I wouldn’t have anybody else but you for the rest of my life. I only recently found out that that wasn’t true.

Today, I am writing to you because this is a day of celebration. It’s been exactly three years since you left me. Since you died. Since you K-K-Killed yourself. This also happens to be my birthday. Mariana said that if I really wanted to be set free, I needed to celebrate this day. I-I-I think this is just her way of trying to get me drunk since I would always refuse to drink with her. NevertheL-L-Less, I am going to celebrate. 

I’m way happier than before especiaL-L-Ly  since I stopped writing to you. With that being said, this will be my last lettE-E-E TO you. I used to say that I’D-D-D never be truly free  but this last letter C-C-Completely  liberA-A-Ates me. Sorry, it’s becoming harder to write with my eyes becoming increasingly more P-P-Puffy. My brain can’t figure out if I should be aL-L-Larmed…or excited. I could never forget A-A-About you because who could forget about their mother? EveN-N-N if they are a mother like you.