Stephen cast his head down while still in confusion and impulsively ruffled his hair. I was just waiting for him to talk. I was sitting opposite him on the right side still fixing my collar which had already been fixed as if it was still a mess— I must be calm and professional. I positioned myself facing my body toward him removing the awkward atmosphere that had occupied us a moment ago.
"Stephen, I should inform you that anything and whatever you will share to me will remain just between us and confidential." I mentioned clasping my hand together then anchored my arms over my lap. "And if you feel that our session is not working, you can ask to terminate the session anytime you opt to." I added.
He remained quiet and shook his head. I was just observing his facial expression based on the angle I could see, his eyes are wide open while his head cast down staring on the stairs, as if his stares permeate through the surface— by the looks of it he was trying his hardest best to think of what to say.
He slightly tilted his head and looked at me "I… don't have the slightest idea, Paul." He voiced in an almost noiseless monotonous tone.
"It's fine, just tell me whatever that comes up." I prompted. "How 'bout you tell me when you first started having this feeling you're having today?" I suggested.
"I can't quite remember… maybe… almost two years ago…" I saw him closing his eyes calculating in his head the years and months that had passed. "No, a year and eight months now. Yeah." He specified and looked at me. This is good. We are starting to have eye contact, which makes this a step forward.
"Could there be a significant lost you have had before that span of time? A relative? At work? Or maybe a shift in your rate of income?"
"No… none at all."
Then what could it be? I thought to myself.
"Your love life maybe?" I asked which made him grin and chuckle and responded promptly.
"I'm happily married Paul, with my beautiful wife." He proudly said.
"Wow! That's pleasing to hear Stephen." I smiled back. "How long have you been together?"
"We're going five years now, this coming October."
"Congrats on your happy marriage life! Is she here now?"
"She's at work, ever since I had been feeling down, she took over for me. I'm so glad I have her. I could not imagine my company crumbling to bits just because I stopped feeling going to my office anymore." He explained with an evident sad display of affect on his face.
I'm starting to have the leeway to probing him about what the cause of all this.
"So, she's been taking care of things for you. That's very thoughtful."
"Including me." He shortly added, then I nodded with a smile. I'm assuming they are not yet blessed with a child since I have not heard or seen anyone in here or that a mother would leave an infant considering that they are still five years into marriage.
"Very thoughtful." I repeated. "She must really love you."
"Yeah, she does. She cooks for me every night after she comes home from work."
"Wow." I leaned closer toward him. "Your wife really cares for you." He cracked a little grin on his face.
There was silence for about more than a minute.
"I'm gonna be honest with you Stephen, I know you from your background. Okay. You built a luxurious company from zero to billion value. How come that you stopped feeling working in your office?" This was asked a bit unprofessional, but by the fact that even he himself knew that he is well-known in this town, it should be just fine that I'd be honest with him about how people think of him or should I say even I think of him, also by the fact that he stated yesterday that I should have an idea who he is just by the name Walpol.
As expected, he did not take it negatively but just answered tiredly. "I don't know… I no longer see any purpose of going… or… or that having pleasure in going there." He explained while cracking his knuckles in both hands one by one using his thumb.
"Have the thoughts of possibilities of what could happen to your company if you stopped caring occurred to you?"
"I've thought of it… but you know… I feel so exhausted every day, and I just feel like laying down. I have no energy to go there." He answered shrugging in every pause as he speaks and each time he lowers his shoulders, it's going lower and lower. "Just pointless…"
Loss of purpose. Feelings of diminished pleasure and interest. Constant feeling of exhaustion. I noted in my mind.
"Saying that, you mean to tell that you have not gone out since then?"
"I haven't gone out, Paul. Ever since… you know?" he looked at me implying at the time frame he had told me a while ago, and I just nodded at him telling him that I understand. "Like I said, there's no point in doing so." He added.
"Let's just go back a bit-" I said and paused as he responded promptly with "Okay."
"You said, you were happily married for five years now." He nodded, waiting for me to continue. "How was you and your wife a year and eight months ago, before you felt this way. How was your sex life." I asked.
"Well… fine I guess." He paused for a while before continuing. "What's the healthy number of times we should have sex?" He curiously asked and waited for my answer.
"There's no exact number of times to it but so long as it is done with both of you consenting to the act and you enjoy it, then it's okay." He nodded as if taking note of it. "How about your sexual drive, before and now?"
"Now is just very bland. I got no energy for it." He responded, then paused and his eyes widened momentarily looking like something had come up. "Maybe that's the reason she looked at me grinning a little bit that night I fell." He said, blankly staring forward.
It caught my attention, that I had asked immediately after he finished speaking. "You fell?"
"Or not… I was just dizzy." He added to his prior statement, contradicting himself in denial.
Now we are really going somewhere. I'm starting to get the gist why there's a change in his mood when we passed by here. I should probe carefully now.
"Let's slow down a bit Stephen." He snapped then bound his look at me. "You fell because you were dizzy, and you saw your wife grinning right after you did?" I arranged the sequence of events he just stated.
"No, I was just seeing things cause I was feeling so dizzy, and my vision was really drowsy that's why I thought I saw her grinned, but she wasn't. She shouted for help right away." He explained.
"Okay, okay." I nodded continuously listening very carefully to him. "You said, you fell. Did it happen here?" I asked.
He stared directly at me before responding. "I'm sorry I reacted aggressively a while ago Paul. It's just that this place really churns my insides whenever I remember what happened that night. I was really sick for more than a week before that happened, and she nursed me all through out the week." He explained.
"It was fine, I completely understand what you're going through." I said, then took a brief moment before speaking again. "Go on." I nodded once to signal to him to continue.
"And now… I'm having negative thought of her smiling for my fall." He expressed himself in agitation then ran his hand through his hair then clenched and pulled as if telling himself to get a grip and think straight.
"When did this actually happened Stephen?"
"A month after I stopped going to work. That was about a year ago."
"A year and approximately eight months." I clarified, then he just nodded at me. "So, you have been feeling depressed for almost two years now, am I right Stephen?" I prompted at him which he did not voice any word and just nodded.
"Was there a time you feel okay and felt going back to work?"
"There was once."
"How was it?" I asked.
"I was thrilled. It lasted almost more than a month, that was when my wife went on a business trip, and I was alone here. That time, I was so excited to tell her that I was swimming again in our pool. But that just lasted quicker than I had expected. As soon as I was to tell her when she came back— the next morning, I felt it again… the unusual fatigue and exhaustion, having no energy and I did not feel the excitement of going swimming again nor even telling her about it anymore… I thought I was really feeling better." He sighed, letting out a very slow exhalation of air making his shoulders fall very low.
Having that I had not brought anything with me to jot down important notes on and I was very complacent that I had mastered doing the Mental Status Exam— I carefully listened to him and processed all he had said. I did not expect our session to immediately begin with a big wave of information like this. Usually, when I do the first session, it is just a matter of what's the patient's complaints are, how they're feeling etc. etc. This session escalated really hard. But with these information—I can tell he is experiencing moderate to severe episodes of depression. Given the fact that the episode has occurred for more than a year but not more than two, then it could be Major Depressive Disorder, bound to Persistent Depressive Disorder or Dysthymia, if this persists just a few more months from now. Additionally, what he just said just now could potentially pass the criteria for a recurrent episode.
"That must be really hard for you Stephen." I said sympathizing with him. He tilted his head down and we paused in silence for a moment.
"Hey, you got your answer why you called me yesterday." I called out, made a thumbs up sign. He raised his head then glanced at me. "That's a start!" I added to motivate him further.
"I guess…"
I noticed as we carry on with the session, he is always tucking his head down, braced by the palm of his hand that appeared like he could not carry the weight of his head up and that he just makes minor movements with his neck just to look and glance at me from time to time. The dark circle under his eyes now becomes more obvious.
"Tell me, Stephen. How much sleep did you get last night?"
"I haven't slept yet." He answered then came after a big yawn, like it has just come to his sense and realized that he had not slept since yesterday. He teared up after yawning which compelled him to rub his eyes. "Now that you mentioned it, I'm feeling really sleepy now Paul. Can we perhaps continue this next time?" he added.
"Yeah, sure Stephen."
He grabbed the railing and stood up. "Before you go, can I at least offer you a glass of juice?"
I stood up slowly followed by a deep breath and smiled. "I'm fine Stephen, you don't have to bother." I extended my hand toward him for a handshake.
"I insist." He grabbed my hand to shake.
"Okay then, I'll just wait outside if it's fine." I smiled.
He took a step down the stairs and spoke on the way down. "I'll just have my maid give it to you. Thank you, Stephen." He continued walking down the stairs then I followed and went on my way out of his mansion.
When I got out, I went by near the gate and waited there. Not long after, Stephen's maid came with a glass of orange juice and gave it to me.
"Thank you." I smiled at her. She smiled back and stood beside me waiting for me to finish drinking.
I raised the glass and took a sip. I could drink it up in one gulp, but I deliberately delayed drinking the glass to empty so I could ask the maid about Stephen.
"Say, how is Stephen doing this past few weeks?" I asked looking at her with the tip of the glass on my lips.
"I think what's been going on with him is really severe." She answered then tilted her head up to look at me and returned a question back at me. "Did it go well?" she asked.
I'm expecting she knows I'm a psychologist. "Oh, the session? Yeah, it did."
She nodded. "He asked us to cook something for him just now. You know, when he started becoming sad and very grumpy, Sir Stephen only eats at dinnertime when Ma'am cooks for him. Maybe it really did go well." She smiled at me.
I finished drinking the juice and handed her the empty glass and smiled. Then I walked and went out of the gate.