The Fake Pathient Two Chapters

Chapter 4. Day two. Tuesday, 10 am. Mr. Christoph Kozlowski. Specialist in psychiatry and psychotherapy. Focus: social phobias (for example, fear of people, blushing, choking, gagging and diarrhea when having to speak in front of an audience)

I’ve picked Mr. Kozlowski because of his name, for I once saw a film with Linda Kozlowski, in which I liked her a lot. She has such a gentle face. Very gentle. In the aforementioned film, she was smart and successful, but got involved in criminal activities and had to be rescued by a man who didn’t even mind killing crocodiles. My grandmother, who allegedly had a love affair with the son of Russian immigrants when she was twenty, claims that she knows a lot about Slavic languages and said the name Kozlowski derives from the noun “Kozel” or “Kosel,” which translates as “male goat.” Oh my, what a grandmother! Sometimes I think that she likes to deliberately belittle everything, especially anything that I personally approve of. But she cannot stop me from visiting Mr. Kozlowski, and my resolve is not only due to the fact that she knows nothing of my experiment.

Mr. Kozlowski does not have a gentle face but rather, just as expected, a masculine one, and this impression is underscored by the fact that he has a beard. His beard is quite well groomed, just as the man himself, who is dressed in a casually elegant manner, in a light-blue shirt and slacks, which discreetly highlight his muscular body. On a dresser next to a large floor-to-ceiling window he, too, has put a coffee machine, together with some thermos carafes, and a wooden box filled with various tea bags. Next to it are a basket of fruit and a sparkling clean fruit blender.

“Help yourself,” is the first thing he says to me, as he stops next to the dresser and watches me. I get somewhat anxious as a result and I’m wondering whether I should not forgo his offer, although I quite fancy a few of the fleshy, aromatic strawberries. As a compromise, I decide on a cup of coffee and push the button for café crème, which catches my eye first.

“You looked at the strawberries with longing but then took a cup of coffee instead. Why is that?” the therapist suddenly asks me, and I realize that the therapy session has already started and that this buffet is not here as a courtesy but serves as a kind of entrance exam.

“Hmm,” I manage to say, standing there with the coffee cup in my hand, as if I had been caught stealing; I don’t quite know what to do next.

“Please have a seat,” the therapist saves me from the awkward position in which he has put me himself. This may turn out to be less fun than I thought.

“You thought that it is impolite to eat strawberries when you are in someone else’s house as a guest. Strawberries—so juicy, so delicious, so full of symbolic meanings, including sensual desire. You preferred to take something more ordinary, something more common, which meets social norms: coffee! Am I right, Frederik?”

I feel like Snow White, standing in front of the disguised stepmother after just having eaten from the poisoned apple. It doesn’t matter why I decided the way I did, I think to myself. And if he believes he can get the upper hand so easily, he is mistaken. In general I don’t like people who lure you into traps and then pretend they want to help you, as if you could gain wisdom only by bitter experience. Therefore I raise my eyes at him and out of nowhere I simply say: “No, actually I’m just allergic to strawberries.”

“Excellent, Frederik!” he says unexpectedly and laughs so loudly and heartily, with his mouth open, that I can almost see his palate.

“What do you mean?” I ask timidly, too timidly, I scold myself mentally.

“Because it’s not important, what your real reason was; it’s much more important that you are defending yourself, that you don’t give in. And you have done that wonderfully! Because you are not allergic to strawberries, I can see that. People with allergies look at this fruit with fear and not with longing.”

“But that can’t be true, because I know a girl who is allergic. She still craves strawberries all the time, and she eats them, too. Every time she ends up getting all red in the face and looks like a strawberry herself afterwards,” I say and realize that I’m talking nonsense, but I’ve already gone too far and cannot turn back.

“Very nice story, Frederik!” the therapist answers, and I get more and more confused and helpless because nothing can throw him off balance.

“You think that I made this up?” I respond. “Otherwise, you wouldn’t say ‘nice story,’ right?”

“That’s right, I do indeed think so. I think that you made this story up to defend yourself, but again, what counts is not whether it is true or not but what is behind it.”

“And what would that be?” I ask laconically and flippantly, which is a bit rude, but by now I’ve grown afraid to say too much, because this man makes mountains out of molehills.

“Before I answer this question, I would like to know if you have a girlfriend, Frederik. Would you be so kind and answer my question, even if you think it’s too direct or too personal?”

His question is exactly that to me, and I would like to refuse to answer. I gather all my strength and tell him this in the same words that just went through my mind.

“All right, Frederik, I’m sorry if I have asked too much of you, but we are already in the diagnostic phase, and, well, I already have two conclusions for you.”

That was fast. I feel very uncomfortable and overwhelmed and don’t say anything to this. I merely raise my eyebrows questioningly.

“First of all, you are not the type of person who gives in fast; you take risks, like the risk of confronting people who seem, for the moment at least, to be in a superior position, i.e. authority figures.”

“You mean like one’s boss or parents?”

“Exactly.”

“And what else?” I’ve recovered myself and can ask this question nonchalantly.

“My second conclusion, Frederik, is that you are not homosexual.”

Oops! That was a hit below the belt, and I don’t know at first whether to take it positive or negative.

The therapist beats me to it. “You look a little as if you might be, Frederik, but you are not. You are simply too shy, but not gay at all. The tall story of the girl you told me clearly suggests that you are in love with a girl or fancy a girl who is as shy as you are, that is, who turns red in the face where strawberries are concerned, a symbol of pleasure, desire, and passion.”

No one has ever dealt with me in such a fast manner, and this somewhat overshadows the happy feeling that slowly but surely starts to spread through my body following the therapist’s finding. But this is not to be the end of it.  After all, I haven’t even presented my complaints yet. The whole time this man has held me in his claws like a vulture a mouse. I now have to bear in mind that I’m a perfectly healthy person and don’t even need this therapist; that, in other words, I have nothing to lose if I keep up my confrontational approach. This thought gives me the necessary strength to tell him something like: “But those questions are not why I’m looking for your help.” This sentence finally achieves the result I wished for, as I glean from his facial expression, which suggests something like Oh, I’ve been outsmarted.

“They aren’t? Oh, I’m very sorry, Frederik,” he says and bashfully changes the position of his crossed legs, so that now the right one is on top. At least this man has the decency to admit having made a mistake. I do appreciate his ability to respond to criticism and now look upon the therapist with a milder eye.

“My questions were of a very different nature, but since we’re already talking about it, I would still like to ask what exactly you meant when you said that I looked a bit homosexual. What makes you think so?”

“Has no one ever told you before? Then you should better be prepared for it, because the gossip of people is sometimes unbearable and can literally lead to isolation.”

I remember that Edi has hinted at some such thing. According to this logic Edi seems to have meant well. “What is it exactly that makes me appear gay?” I repeat my question, putting it somewhat more eloquently in order to impress my vis-à-vis.

“I need to think about it, Frederik, because first of all, it is a kind of gut feeling that one has. Explanations are a matter of the mind, and the mind needs more time, as is generally known.” The therapist re-crosses his legs again, the other way around; this could be a sign of anxiety, because I observe it in my father every time he talks to my mother.

“But I don’t want you to think that I have anything against homosexuals, Frederik, and to prove it…” Here the therapist takes his time before finishing the sentence: “… I want to reveal to you that I’m homosexual myself. And I tell you this because I’ve been fighting for an open approach to this issue for years. „

That sounds totally fine to me. Although I don’t know whether I am for or against people being open about this or other issues, it doesn’t matter to me at this moment. What matters is that this man, by virtue of his openness, has just turned into a nice person, and I can ask my next question at ease: “All right, I understand, but now to something completely different. I also understood what you said about authority figures, but regarding the girl …”

“Little Red Riding Hood?” he interrupts me.

“I beg your pardon?”

“Didn’t you say she has a red head”?

“Not that she has a red head but that she turns red in the face when she eats strawberries,” I correct him emphatically.

“So she’s not a redhead?”

I’m amazed. “She is, but I didn’t say so, and besides, what does it matter?”

“Come on, Frederik, that’s obvious. This story with the strawberries and the red head came pouring out of you so quickly that it could not be any different with the girl. It was a free association. Free associations, especially those that are so spontaneous and unprompted, always have a lot of truth to them.”

I have to think about this, because I’m impressed by it and not just a little, but it’d be better to do this at home. “Interesting,” I say therefore. “And how do we proceed, how do I find out what is going on with the girl? Because I have great doubts that I’m in love with her.”

He looks at me in disbelief for a while. “Please re-read the tale of Little Red Riding Hood at home. I’m sure that you remember it only vaguely. Next week we’ll then talk about it, Frederik.”

With that, he stands up and says goodbye.

I don’t like getting homework. I haven’t done any for several years. But maybe I’ll have my grandmother tell me the fairy tale; that’ll make her happy.

Or will she wonder? No, she won’t wonder about it. In my family, no one really wonders about me anymore.

*********************

Chapter 5. Day three. Dr. Rödiger. Specialist in psychiatry and psychotherapy with a focus on
obsessive-compulsive disorder

On his homepage Dr. Rödiger points out that the announcement about his retirement being imminent is just a rumor. On the contrary, he is in great shape and hopes to remain so for many years to come, in order to continue helping his patients with all his body and soul.

I have spent an hour pondering what he could possibly mean by “all his body,” but haven’t come to any conclusions. At Mr. Rödiger’s, I want to show up as a patient suffering from OCD, I already know that much.

By now I only have a small breakfast at home and don’t drink any coffee, because so far I’ve always been offered coffee or tea at my appointments. The meeting with Mr. Rödiger isn’t scheduled to take place until 11 am but that’s okay, I can make do without coffee until then. My mother would not be able to do that, because she has very low blood pressure and has even fainted because of it a few times. My grandmother claims, however, that this was not due to her blood pressure but to a certain hysteria, which my mother had developed in early childhood, because she was rarely refused her wishes. I have looked into hysteria; it’s about something else. Frankly, I’ve been very happy ever since that I don’t have a uterus. For if what the analysts of the last century contended should be true—namely, that women who suffer from an unfulfilled desire to have children are beset by hysteria—then I, as a man, even though childless, am on the safe side. According to that theory my mother cannot have hysteria, because she has a child. Even as I write this down, it occurs to me, though, that I haven’t really thought about whether or not I really fulfill my mother’s desire to have a child. On the other hand, she does always say that I’m very important to her, that I saved her from the loneliness of her marriage. I think that is proof enough that she loves me. And now back to the coffee. I’m just asking myself whether I do this for economical reasons—I mean, not to drink coffee at home. Rather unlikely, because as you know we have more than enough money, and I could afford it. A possible reason, it occurs to me now, is my good upbringing. I don’t want to appear rude. I can’t think of any other reasons, but I have read that people do not always know why they do what they do and that that is, among other things, the reason why so much nonsense happens in the world. For now, I’m satisfied with this.

Today I must look especially neat, because I want to appear as if I am concerned with cleanliness, law, and order. This is not particularly difficult, because my shirts are always perfectly ironed, as is my underwear for that matter.

Mr. Rödiger doesn’t open the door to his practice until ten minutes after I have rung the doorbell, just as I am about to reach for it for the second time. He looks at me somewhat surprised, probably even rather puzzled, and I think hard about whether I have not confused the dates. That would be quite something—that is not something that would happen to a compulsive perfectionist. I get a little worried, because it might give me away. Thankfully, Mr. Rödiger gestures for me to come in and follow him. We walk through a narrow hallway, which is a bit dark, so I have to watch my steps. The floorboards creak beneath our feet. The sound of my host’s steps is somewhat out of rhythm; I think he relies more on one foot and places only minimal weight on the other. This could well be due to pain. Poor man. Meanwhile, I wonder why there is no lighting here, but then we reach the end of the hallway, and Mr. Rödiger opens the door to the adjoining room. It seems like a birth to me, because, after all, birth is also concerned with passing through a narrow, dark passageway into the open. The room is large, and there is a lot of light, because there are no curtains on the windows and it happens to be a sunny day. The walls are covered with fabric wallpaper, just as in my grandmother’s house. I like that, it looks cozy. The leather of the two deep armchairs that face each other in the middle of the room is a bit torn, but this only improves my impression, because it suggests that many patients have sat in them and that my therapist for today is an experienced professional. The desk looks towards the window, if it can look anywhere at all for it shrinks into itself under a one-and-a-half-foot-high pile of books and papers. There are also some coffee cups and two thermoses, which are probably empty, because they lack lids. But nowhere do I see a coffee maker. Oh dear.

Mr. Rödiger offers me a chair, but remains standing himself and starts looking for something. He is indeed a bit older than the other two I met this week, almost as old as my grandmother, I guess, who is eighty-two. For a while he stands with his back to me at his desk and rummages through the mess. As for his hairstyle, he has a head like Albert Einstein; his dark blue jacket is a bit lopsided on the right, but this is due to his right shoulder, which appears to be a bit lower. At this moment my psychiatrist for today finds what he was looking for and with a joyful expression turns to face me, holding his calendar in his hand, and he has already found my name in it, too.

“Frederik, 11 am. All right. Then everything has worked well so far, hasn’t it?” he says and sits down opposite me. “How can I help you, Frederik?” he asks bluntly, and I feel a bit unprepared due to this suddenness.

“I suffer from OCD,” I say quickly to hide my uncertainty.

“Ah!” my vis-à-vis replies. “You already know your diagnosis? How unusual. Normally the patients first describe their signs and symptoms and the diagnosis follows and is determined by the physician.” He smiles at me conspiratorially. “Or have you already been to see a colleague?”

I come back to my senses quickly. “I read about it,” I say confidently. I don’t have to answer his question about whether I have seen someone else. One must not lie, but concealing things is another matter entirely.

“And how exactly do your symptoms manifest, I mean your signs of compulsion, Frederik, if that is indeed what they are?”

I just can’t stand mistrust, which I’m familiar with from my school days. Whenever I got stomach pain during class, I was accused of wanting to play hooky. Until finally a physician performed an appendectomy on me. Lucky for me, because he also found out that my right testicle was stuck in the abdominal cavity. I’m very grateful to this surgeon, because my testicle has since been in the right place.

“On some days I can’t even leave the house because all the checks I have to perform—whether all burners are off, all electrical cords are unplugged, all windows are closed, and all locks are bolted—take an incredible amount of time,” I say then, a bit annoyed because this man is not taking me seriously.

“An incredible amount? How much exactly, Frederik? In psychiatry, there is nothing that can be called incredible.”

Good to know. Especially that I should learn this from a man who has just insinuated that I am a malingerer. (Putting my experiment to the side.) “On average?” I say testily. “Let me think, or better, add up. My stove has four burners, which I must each touch individually three times to determine if they are cold. Then I look at the knobs, which must be at zero. I also have to check whether what I see is indeed a zero. To this end, I have had a graphic designer write the numbers from zero to nine, organized in a row, on a sheet, and put it up in a frame above the stove. Then the inspections regarding the windows …”

“And how long has this been going on, Frederik; since when have you had this disorder?” the psychiatrist interrupts me. Suddenly he does not seem to want to know the details.

“Ever since I was eighteen,” I answer, because this is what comes to my mind right away.

My conversation partner mulls this over. “What do you do professionally, Frederik?” he asks.

I don’t know how to answer that. But I do have to come up with a plausible answer, or I can’t proceed here. I don’t want to tell him the truth—I don’t know why.

“I do shift work at a factory. I’m actually very good at quickly reconfiguring machines when they need them to produce different parts. My employer is very happy with me, and gives me a watch every Christmas because of it.” I feel pretty pathetic; I have told a lie. Even worse, I’ve pretended to be Edi.

“How have you managed to keep your job so far in view of your mental disorder with its time-consuming checking rituals?” the psychiatrist wants to know and raises his eyebrows. For the first time I feel taken seriously. His voice even resonates with a certain warmth.

“You get by somehow, you know.”

“You do seem to have a lot of potential; that’s excellent,” the old man almost keels over, with enthusiasm, I suppose. Under different circumstances, I would have thought that he has gotten dizzy somehow. I feel great, because no one has ever told me that I have potential.

“We have a lot of work ahead of us, Frederik, but I am very confident. I will accompany you in your fight against this disgusting illness. Now would you please excuse me for a moment,” he says rather melodramatically and leaves the room. I welcome a short break to enjoy the extremely positive turn the conversation has taken for a bit. Out of sheer joy I forget that I have passed myself off as Edi. Does that mean that I have to imagine myself as Edi in order to feel good? I have to think about that. From somewhere behind the wall to my left I hear the sound of a toilet flushing. I look at my watch. The session is moving towards its end, only a mere twelve minutes are left. But these pass without the therapist returning. I’m getting restless.

Outside the doorbell rings. I perk up my ears and listen for other noises behind the wall to the left, the possible location of Mr. Rödiger’s private rooms, but to no avail. I anxiously look around, and when it rings for the second time five minutes later, I consider leaving and opening the door for the visitor or the next patient at the same time. Looking ahead, I leave the door of the bright treatment room open and thus reach the front door without problem.

There a happy face smiles at me. It belongs to a guy who is probably slightly younger than me.

“Mr. Rödiger?” he asks pleasantly and smiles at me again.

“Yes, uh … why don’t you come in, I’m actually a …,” I say vaguely, but do not finish the sentence and turn back to show him the way. Just then, the door to the treatment room falls shut, probably due to the draft. I choose to be polite, and, as there is still no sign of the therapist, decide not to leave the young man standing  in front of the door. “Follow me,” I say simply and walk ahead. In the treatment room I point to the patient’s chair and am about to leave. But then I stop briefly; I want to wish the young lad much success—I feel an intimate connection with him, since I am also a patient, even if only a pretend one.

“Uh, what I wanted to get off my chest right away,” I hear him say, “I’m incredibly grateful to you for giving me this appointment so quickly. As a statutory-insured patient you are not always so lucky.”

I have never heard the term “statutory-insured” before and turn to face the young man curiously. “What do you mean … statutory-what?”

“You do know I’m covered by statutory health insurance? Please don’t tell me you didn’t know and don’t have time to see me after all…”

The boy seems so sad all of a sudden that I simply can’t leave. “Oh, nonsense! Statutory insurance is okay; everything that has to do with the laws of a constitutional state is fine as far as I’m concerned,” I reassure him. In truth I have no idea what I’m talking about.

The young man breathes a sigh of relief. “Well, thank you very much. Please call me Alex, this will make me feel more comfortable than if you address me by my last name.”

I respond by approaching him and giving him my hand. “Nice to meet you, Alex. Frederik.”

“No, just Alex, please. And I would like to begin now. I’m so incredibly tense, you know.”

I’m still standing in front of him at a complete loss, so flummoxed that I cannot even think about how to get out of this fix, when he plunges in.

“I suffer from OCD and I’ve come to you because you are a specialist for it.”

I feel strangely tempted to tell him what I heard from the therapist a few minutes earlier. Ultimately, I can’t resist the urge. “What, you already know your diagnosis? Very unusual. Normally the patients first describe their signs and symptoms and the diagnosis follows and is determined by the physician.” I realize that I have intimidated the young man, and I regret it deeply. He lowers his eyes to the ground.

“I’ve been in treatment for a long time,” he says softly, “but so far it hasn’t gotten any better. Honestly, I have no more strength to wait and hope for it. Wouldn’t you please sit down? It makes me nervous when you stand in front of me like that.”

“Oh yes, of course.” I don’t know why I say that. Probably because I feel very sorry for Alex, and I don’t want to let him down. I sit down in the therapist’s chair and try to remember what I learned about the development and treatment of OCD when I read about it in the preparatory phase of my experiment. My memory serves me well. It has done so since early childhood, because I was always good at memorizing quickly, poems, for example.

“Please tell me more. How exactly does your OCD manifest, Alex?” I ask.

“Obsessive washing, very distressing. I think that I get dirty even from smells and words; I have to shower and wash my clothes often. Don’t you smell anything? A friend of mine says that I always smell of detergent. My mother, with whom I still live together, complains that the detergent runs out very quickly because I use huge amounts of it.”

I pause and think hard about what my next question should be. I want to help the boy. I’ve always wanted to have a brother, regardless of whether younger or older than me. “And is there something right here, in this room, that could sully you, do you have the urge to take a shower right now too?” I ask.

“Well. I want to be honest with you. It looks a little messy here, quite in contrast to yourself—the way you are dressed, I mean. That surprises me a little. But I didn’t have to touch anything here, so I have no particular urge just now.”

The compliment about my appearance raises my spirits, and I simply continue inquiring about his disease symptoms. In professional terminology this is called the “exploratory phase.” But secretly, I think that I just want to get to know this guy because he’s likeable.

“We have a lot of work ahead of us, but I’m confident. Now, however, I should first learn a bit more about you and your daily life. What do you do, Alex?”

“I work in a bakery. For about five years. The work is difficult because I have to get up very early, but you struggle through it, you know.”

“It’s quite amazing that you’ve managed to keep your job, with this disgusting disease. You seem to have a lot of energy,” I repeat more or less what the therapist told me.

“You think so? Oh, no one has ever said to me; I feel in very good hands with you.”

The conversation with Alex is going great, we just harmonize well. That’s actually a good sign. I’ve read that the first requirement for a successful therapy is empathy towards the patient. This I can offer easily. I lean back in my chair and simply continue to ask questions. Meanwhile, I don’t know why the questions flow from my mouth so easily. It does not matter. “You said that you still live with your mother, but what is your life like otherwise—do you have a girlfriend, perhaps even children?”

“Yeah, right, children, girlfriend! Do you think any woman wants to be with a freak like me who has to take a whole shower every time he uses the toilet, let alone when he has smelled or touched something?”

I try to imagine it. It does indeed seem a bit complicated. Should I just say so to Alex? Rule number two of a therapeutic stance is to be honest and authentic.

“To be honest, Alex, that seems very unlikely to me, I mean that a woman could imagine such a thing. Unless …”

“Unless?” Alex asks curiously.

“Unless she suffers from the same condition as you do.”

Alex seems to think about it. “Hmm, not a bad idea, you know. Because clearly I’m not the only one and there also women who are affected. I have an idea, maybe I can start to attend a support group, and perhaps I could meet a woman there and make friends with her!”

Alex is full of enthusiasm, and I’m glad that I was the one who brought him there. I know what a support group, or a self-help group, does, of course, from the books that I have read. Self-help means to “help yourself,” of course—we all know the expression “God helps those who help themselves,” which probably amounts to the same thing. Applied to a group, it means that people come together who each strive to help themselves—they need the others around them simply in order to not feel so alone, because as we all know God is not always available. For that matter, my grandma always says that God, old as he must be by now, has to take naps more and more often. And during that time people do nothing but nonsense. But I’ve gone off track.

Somewhere behind the wall I hear the toilet flushing again. This brings me back to reality. The therapist has still not shown up, while I’m sitting in his chair. Oh dear! I have to leave. A glance at my watch tells me that Alex’s session is over by now. Alex has noticed my glance and senses that he must go. He seems dejected.

“Are we still on for meeting every Wednesday at noon?” he asks hopefully.

I reply without missing a beat; I seem to have developed feelings for Alex and apparently can’t act any other way. “But of course we are, Alex,” I say, without thinking of the consequences.

Alex gives me a happy smile and gets up. “Thank you very much. I really enjoyed my session with you,” he says, before he walks to the door. I look around briefly and decide to come along, because I don’t want to risk being caught by Mr. Rödiger any longer.

“Time for your lunch break?” Alex asks when he sees that I have followed him outside.

“Yes,” I nod and say goodbye to him.

At that moment I did not yet know of what crucial importance the fact that I have left Mr. Rödiger’s house together with Alex would be to me. Back then I just thought that I too had enjoyed the session a lot and that psychotherapy can truly work wonders.

 ………