From PRUFROCK, J. Alfred, Intake Records

From: Fleas on the Dog Magazine

CASE NO: 9924:
CLIENT: Prufrock, J. Alfred (first name unk. May be artifactual or affectational)
AGE: Unk. Admits to “old”
DIAGNOSIS: Primary: Major Depression, DSM IV. Secondary: Generalized Anxiety Disorder with dysthymia, sexual fetishism / fixation, sexual excitation of senescence

ACTIVITY: Discuss “Love Song” generated in writing therapy.

SUMMARY ASSESSMENT: Mr. Prufrock’s writings reveal depression and florid ideation secondary to cognitive decline with sexual fixation. His problems appear consequent to
impaired concentration, and I recommend continued regression therapy. Also advise increasing his Chlorpromazine to 1,000 mg. and supplementing with Alprazolam 4 mg. daily p.r.n., continuing with the Captopril, anticholinergics as needed and starting on Zoloft 50 mg. once daily. Watch for drowsiness and falling.

REPORT:
Patient presents as an elderly, cachectic gentleman with a distinctive shuffling gait and arrestingly ‘rolled’ trousers. He avoids eye contact. I advised him that we were going to
discuss his “Love Song,” and that staff and other patients had found some of his statements troubling.

Mr. Prufrock admitted to writing the phrase, “When evening is spread out against the sky like a patient etherized upon a table.” He denies using anesthetics, barbiturates or hypnotics upon women. He says he meant only “symbolically” his invitation to “half deserted streets,” and “one-night cheap hotels” and that his “insidious intent” does not indicate desire to harm.

Mr. Prufrock’s rambling evinces a neurological deficit, probably due to a series of minor strokes in Broca’s region. He persists in ascribing human behavior to non-human phenomena, such as smoke that can “rub its muzzle” or “fall asleep.” In reference to “the women come and go talking of Michelangelo,” he was evasive about homosexuality. When I asked him to expand on “licking…its tongue into corners,” Prufrock agreed that this could be interpreted as sexual. Shortly thereafter, he wrote
about “soot” and expressed fear of self-soiling. I pressed him on references to “yellow fog” and “yellow smoke” vis a vis medication-induced flatus. He refused to answer, but I am prescribing Simethicone.

I read back to him the phrases encompassing “there will be time… to murder” and “time for you and time for me… before the taking of toast and tea.” Although evasive, he finally agreed that this could be interpreted as threats. His writings did reveal a hesitancy about acting out, as in “Do I dare and do I dare.” I supported this hesitancy, as a sign of superego engagement, which argues against Dr. Lickmoss’s initial impession.

In his writing, he expresses fears that “people” are talking behind his back about “how his arms and legs are thin” which fuels his dressing rituals. He also claims to be “measuring out life with coffee spoons.” I queried whether such measuring ever involves blood, saliva or semen, and he became evasive.
Mr. Prufrock expresses fears of persecution from “the eyes that fix you.” His paranoia has increased lately, and he also admits to masochistic ideation of being restrained with sharp objects “pinned and wriggling on the wall.” He fantasizes expectorating “…the butt ends of my days and ways” but denies coprophilia.

In his writing, Mr. Prufrock asserts having “known” a number of women “by their arms” and admits to stalking them through “narrow streets.” He is evasive as to the phrase ragged claws scuttling underwater.” I pressed him on what he intended by “forcing the moment to its crisis,” and he denied rape fantasy.
He admits that his expression of “Lazarus come from the dead” could conceivably relate to receiving messages from beyond the grave. He also wrote of weeping, fasting, praying, and hallucinating his own head “brought in upon a platter.” He explained that this was not cannibalistic ideation but rather concern about his baldness. Mr. Prufrock admits that he is fixated upon his bald spot; he denies hair-pulling and agrees to consider a toupee.

As to his declaration that he could roll the “universe into a ball,” I asked him whether he believed it was possible for a person to do that, and he responded, “I wrote it, didn’t I?” The need to shorten his trouser bottoms may be caused by spinal osteoporosis: I prescribed Reclast infusion. As to his anxiety about whether he “dares to eat a peach,” I reassured him that stone fruits are fine as long as he peels the skin due to his problems with roughage. He might try enzymes or anticholinergics. (Hycosamine p.r.n. to decrease stomach/intestinal spasms and Phenyltoloxamine, watch for drowsiness and falling.)

Mr. Prufrock admits hallucinating mermaids “singing each to each” and to being upset that they rejected him in favor of engaging in sexual relations with one another. He complains that they refuse to sing to him and flee his advances. His writing exercise ended with a confusing reference to human voices waking us and a fear of drowning. I recommend another assessment in two weeks and continuing hospitalization for now.