MARK

Mark was a junior medical student when he approached me after my lecture. He was neatly dressed in shirt and tie, unlike most University of California students. He needed my help because he was in a slump. He tried to study, but the sentences seemed jumbled. He was unable to sleep and began to drink in order to relax. He spent most of his time in unproductively planning how to study. He developed three different index systems for notes but was unable to read the notes after indexing them. He was so anxious about his studies that he seldom left his room at night. He neglected to write to his mother and sister and forgot to return their telephone calls.When Mark had first entered medical school, he earned excellent grades and received a special commendation in biochemistry. He elected training in basic science research. He was accepted by one of the best fraternities, which was adjacent to the nurses' dormitory. Although Mark was inexperi enced, he soon found several attractive nursing students who were fascinated by his sensitive, sympathetic manner. Intrigued, he spent many an evening chatting and, eventually, in making love. Although he studied less, he ranked in the top ten percent of his class.

Midway through his sophomore year, Mark was introduced to a red-haired, curvaceous nursing instructor several years his senior. She invited him to her apartment for scampi the next night. That evening Mark was vaguely uncomfortable, although the shrimp were delicious and the wine well chosen. After dinner it became clear that the dessert would be served in the bedroom. Mark was impotent for the first time. His partner, who had heard tales of his athletic prowess, was offended and peevish.
By the end of his sophomore year, Mark was less involved with the nurses and more concerned with his school achievement. He felt that the noise of the fraternity house interfered with his studies, so he rented a small studio apartment three blocks from the hospital.
Mark's father was a distinguished professor of economics in a small but well-acclaimed college. He was home more than other fathers, but was largely occupied with lecture notes and the preparation of a textbook. The mother described him as her "absentminded professor." He never remembered birthdays or anniversaries and often forgot to kiss his wife good-bye. Yet he was concerned and thoughtful whenever problems arose. Mark's mother readily shouldered all major family responsibilities, such as paying bills and arranging for home repairs. When Mark reached school age he helped by raking the yard and washing the car. Intelligent and likable, Mark was elected president of his tenth-grade high school class. He was a part-time printer's assistant for the town newspaper and played an excellent game of tennis. He was shy with girls, although he dated occasionally.

After several months of therapy, Mark associated his poor concentration and depression to his confrontation with the nursing instructor. Following that, he had systematically chopped away every source of pleasure. He no longer played tennis, listened to classical music, or attended a movie. He drank alone, to quiet his nerves rather than for enjoyment. When his mother asked him about medical school, he replied in vague generalities, although he had always enjoyed her attentions. He felt strangely inadequate, as if he didn't deserve her interest.

One day, Mark recounted a terrifying dream. He was driving along a lovely seacoast on a winding, cliffside road. He jabbered excitedly to his mother, who sat behind him. The road abruptly ended, and the car swerved out of control and plunged over the cliff toward the water. His hands shook as he recalled his terror. Next Mark described a family reunion where he was taken when he was five years old. Because of limited sleeping space he was placed crosswise in a double bed with three girls. In the middle of the night he awoke to find his pajamas warm and moist. He had drenched himself, the bed, and its three other occupants. Mother was mortified. She announced to all that Mark had never in his life done such a thing. Crestfallen, Mark walked by himself at the edge of the creek. Then he remembered a different scene. When he was ten, his family lived next door to a house with many children. Mark persuaded the twelve-year-old neighbor to entice his five-year-old sister, Janie, to give them a "show." The boy agreed although he lacked personal interest, as he saw his little sister nude almost every night. Janie gladly lowered her panties and spread her legs for a candy bar. Mark peered closely but was afraid to touch. Suddenly ashamed, he left the shed, even though Janie wanted to do it again for another candy bar. Thereafter, he avoided Janie and her entire family. He told his mother they were all lazy people. Yet he thought of Janie when he began to masturbate at age twelve. He tabulated each orgasm, timed it, and carefully caught the semen in a tissue.