Losers Like Us

Remus Lupin (1)

Relevant Intake Information:

Client: Lupin, Remus.

Age: 37

DOB: March 10, 1959

Race: Magical, Caucasian

Intake Date: July 1, 1996

Referred by: St Mungo's Hospital

Session One: July 1, 1996

Goals: Form therapeutic alliance w/[with] ind[ividual--i.e. patient]. Develop goals for treatment w/ ind.

Sxs[Symptoms]: Ind reports low mood, lasting previous 2 years, parallel w/ significant losses in personal life. Tearful. Chronic illness [unspecified], resulting in periodic weakness, loss in physical strength. Currently unemployed, lives on small income. Reduced eating, sleeping patterns, some weight loss. Trust issues w/ th.

Interventions & Response: Th reviewed intake info provided by ind, reviewed policies re: confidentiality, abuse reporting, scheduling of meetings, payment policies. Appro releases signed, inclu release to St. Mungo's for relevant health info. When asked what he wants from therapy, ind stated, "Just help. All my loved ones are dying." Ind then became tearful, wept quietly through rest of session. Th asked permission, held ind's hand loosely. Ind unable to provide further details. Th allowed ind to determine end of session; session lasted approx'ly 90 mins. Ind apologized near end of session; th advised ind that therapy "is whatever you need it to be right now." Suicide Assessment: no means, no plan, no history of attempts. Ind reports no desire to harm self at this time. Risk low. Th gave ind her card, advised ind to contact th as needed, 24/7. Th advised ind to continue working w/ St. Mungo's Healer re: any mood-modifying magic. Ind laughed weakly, said "they told me to do that w/ you." Th advised ind that he is not alone & had "team" now of St M's & th. Ind held both th's hands briefly, left room rapidly.

Plan: Review case w/ St. M's for possible spells in use at this time. Continue working w/ ind to formulate therapeutic goals. Help ind to reduce depressive sxs as possible.

Diagnosis:

Axis 1: Major Depressive Disorder

Axis 2: Dx[diagnosis] deferred

Axis 3: Unspecified chronic illness, reported to "run in monthly cycles", leads to periodic weakness, apathy

Axis 4: Significant recent losses among primary support group. Low income. Chronic illness.

Axis 5: 61

Personal Process Note, July 1, 1996:

Remus Lupin, in my office, which is really the study of my cottage here in Hogsmeade, and which really triggered him somehow. Fantastic. If only he could have told me why it triggered him. Instead, all I got from him was, "Do you have any idea who owned this place before you?"

Why does everyone ask that? Yes, I know, I know already! But I said that much more gently to Mr. Lupin, who was gazing around the room with a look of controlled horror. I rushed right into, "What brings you to see me today?" and the earth seemed to fall out from under the poor guy's feet. "All my loved ones are dying."

And then 90 minutes of tears. Worst of all, tears do not come easily to this man. He is thin, rather on the tall side, with light brown hair that is far too gray for a man roughly my own age. When he weeps, he does it utterly silently, hands over his face, and body shaking (one cannot help thinking) half with grief and half with resentment that he has allowed himself to reach such a depth again or to be seen when so low. His entire body resists. Within ten seconds of his starting, I wanted to clutch at him and beg him to just let go, let it out, since watching his struggle was hurting me.

But that would be for my benefit, and we are here for his. Instead, I asked to hold his hand, and he surprised me by nodding, then by clenching my paw for dear life. But he still covered his face with the other hand. My heart went into my shoes. I murmured the right, therapeutic things to him, naturally. I told him it was okay to cry here, that I am bound to strict confidence, that he is doing good work in therapy simply by being able to do this in front of me.

Talk about the Endless Session from Hell. Remind me: why do I see depressed people? Only once did he react to my words in any way that I could see. When I said, "I am honored that you allow yourself to let go here, in front of me," he gave me a startled look, as if I had begun to foam at the mouth or rave at him in some bizarre way. Great. Low self-esteem to add to the mix.

Really, I don't know how long he would have wept, but the initiation of the nightly crashing from the kitchen stopped him. I used my grip on his hand to hold him in his chair, smiled my best phony smile, and explained that it was "another being" who chooses to be in my kitchen. Looking puzzled, Lupin says, "I saw a house elf in there when I came in..." Then the light dawns; he exclaims, "You're seeing an house elf for therapy?"

Well, I certainly suck at confidentiality, don't I? Good thing Fearless probably won't think to sue for this gaffe. Like I have any idea who she'd go to, if she wanted to sue me, in this magical world I now inhabit. Anyway, Lupin has the sense to perceive my embarrassment and backs off the subject immediately. We talk about him continuing to work w/ St. M's, but I am getting the feeling that they have given up on him, for some reason.

Hopefully, I scream, "Fearless! We need some tea in here!" That's the joy of working in private practice in Great Britain: you can actually give a patient a soothing cup of tea. And the exercise would be good for her. Unfortunately, through the doorway flies a cup, followed by a saucer, followed by some teabags. Lupin is all over it, thank heavens, before I can react. Before the scalding water shoots in, he has his wand out and is saying yet another incantation that somebody surely has taught me, and that I have managed to forget already. All the tea things freeze in midair. The suspended blob of steaming water would look decorative, if I hadn't already been bracing myself to be burned.

Apologetically, as if he has caught me out--and he has--Remus Lupin smiles weakly at me. "You like a challenge, Doctor?" It is more statement than question. "Good." Then he calls: "Thank you very much, Fearless. I'll just be sending the tea things back, shall I? And perhaps we can have loose tea next time, instead of the bags?" Wave of wand, parade of retreating homicidal tea goodies. That's the terror of working in Great Britain's Magical Community: you never know how anything is going to work out.

To the accompaniment of more crashes and shattering sounds from my kitchen, Lupin schedules a meeting for the same time next week. I wonder if he'll really return.

Session Two: July 8, 1996

Goals: Form therapeutic alliance w/[with] ind. Reduce depressive sxs aeb (as evidenced by) ind will identify his remaining support group and practice telling them his feelings. Ind will create and work on schedule of appro[priate] eating and sleeping habits.

Sxs: Low mood, lasting previous 2 years, parallel w/ significant losses in personal life. Chronic illness [unspecified], resulting in periodic weakness, loss in physical strength. Currently unemployed, lives on small income. Reduced eating, sleeping patterns, some weight loss. Withdrawal from social group. Trust issues w/ th.

Interventions & Response: Th developed goals, as above, w/ ind. Ind presented as quiet, withdrawn, but polite, very patient w/ th, expressed embarrassment re: bx[behavior] previous session. Clothes worn, mended, but neat. Bags under eyes, some watering of eyes throughout session. Th supported ind in reviewing reasons for his statement prev[ious] session that "All my loved ones are dying." Ind described recent events, inclu[ding] involvement in battle at Ministry of Magic, in which childhood friend was killed by allies of Dark Lord. Ind reviewed personal history, described close bonds w/ 3 friends dating from secondary school (Hogwarts). Ind became tearful, described how one close friend killed second friend and wife, while 3^rd friend blamed for murders, jailed for 12 years in inhumane conditions, w/o trial. Before 3^rd friend could be cleared of charges, killed in above-named battle. Murdering friend now serves Dark Lord. Ind expressed guilt bec[ause] he also mourns for murderer as lost friend, begged th not to tell anyone. Th expressed concern, due to dual relationship on th's part, as th personally acquainted w/ other person (minor) involved in ind's history. Ind reports that he knows of th's bond w/ 3^rd party, gave th verbal permission to speak w/ 3^rd party to complete info re: recent battle. Th, ind agreed to work closely on keeping 3^rd party out of involvement in ind's therapy, review situation as required to maintain appro[priate] therapeutic atmosphere for ind. Ind expressed concern that 3^rd party also will die in immediate future, due to involvement w/ ind & friends. Suicide Assessment: no means, no plan, no history of attempts. Ind reports no desire to harm self at this time. Risk low.

Plan: Review case w/ St. M's for possible spells in use at this time. Help ind to reduce depressive sxs as possible.

Consultation Progress Note: July 8, 1996

Present: GD Walker, Ph.D.; Augustus Pye, Trainee Healer, St Mungo's.

Reason for Meeting: Discuss ind's need for anti-depressive spells, magical strategies to support ind's coping w/ depressive sxs.

Discussion: Dr W described content of intake assessment, 1^st interview, 2^nd interview, including concerns that ind reports Axis 3 medical dx, which he is unwilling to reveal to th at this time. Healer reports that ind no longer benefiting from "traditional" magical treatments for depression, but still medicated for chronic illness. Healer reports that he [Healer] assigned to case bec he supports experiments w/ Muggle medical approaches, had referred ind to Dr. W for "Muggle-oriented" therapy. Healer expressed reluctance to "out" ind's medical condition, asked th to continue trying to help ind reveal condition as part of therapy.

Plan: Dr W will continue to work w/ ind along more "traditional" Muggle therapeutic approaches.

Personal Journal, July 8, 1996

So Lupin turns out to have every reason in the world to be miserable. "Help ind to reduce depressive sxs as possible." In a case like this one, it sounds like a rancid joke. What do I have to offer him next to so much loss? I can't revive any of them, make them tell him "Hey, no problem! We like it dead." Oh, except for the one who is still alive; he'd have to say "It's a party every day, working for the Dark Lord." Not.

Sure, Remus is smack in the middle of a depressive episode. Who wouldn't be? Much as I'd like Gus Pye to wave his magic wand and fix up Lupin, the Healer makes a good point: there is no magic to surviving grief. Other humans help you get through it. If you are going to get through it, that is. Anyway, Muggle therapy works as well as any other option, and the man does not present as suicidal. I really think his mysterious medical condition matters here, but Gus is right: what good is therapy if Lupin cannot trust me enough to tell me himself?

Here's the kicker: I know who Lupin's friends were. Why does Harry Potter have to be involved in everything that goes wrong around here? Why, why, why? And if Remus saw Sirius Black die in that battle, why didn't Harry tell me? Where is Harry now? How is he coping? Why didn't he come to me? Have we become too much friends to be therapist and patient again? Can't he trust me anymore?

Of course he can't. He's out of the habit. I'm not his mother; I'm the professional surrogate used by people when they think their friends cannot take it. Harry's had people to "take it" from him for years now. I taught him how to do that, in fact, when he was 9 years old. What did I expect?

Of course, he only comes to me now for tea every now and then, to see how I'm getting on, and to chat and update me. Harry himself has been telling me all along that he's got father-substitutes galore these days. He's too old to be looking for a sub for the "mum" job, but he's got that too, in young Weasley's mother.

But Harry's just lost his favorite father-figure. Where is Harry now? With those horrid relatives? How is he coping? Does he still have my card? Can he use the phone, if he has to? Can I use the fireplace, if I have to? Or has Fearless still got it piled up with junk she's somehow managed to glue into an immovable mass?

Session 3: July 15, 1996

Goals: Reduce depressive sxs aeb ind will identify his remaining support group and practice telling them his feelings. Ind will create and work on schedule of appro eating and sleeping habits.

Sxs: Low mood, lasting previous 2 years, parallel w/ significant losses in personal life. Chronic illness [unspecified], resulting in periodic weakness, loss in physical strength. Currently unemployed, lives on small income. Reduced eating, sleeping patterns, some weight loss. Withdrawal from social group. Trust issues w/ th.

Interventions & Response: Ind reports that he is terminating therapy, as he cannot "see the point", believes that th cannot help him. Th agreed that she cannot help if ind not ready to do therapy, asked ind if he will "share cup of tea" as farewell ritual to humor th. Ind looked surprised, agreed. Th called to kitchen for tea for two. Crashes from kitchen, sounds of breaking glass. Ind went to kitchen, magicked objects to proper places, ordered house elf to "clean that filthy basement", helped make appro tea when elf gone. Th observed that ind good at "setting things straight," explained that th unable to manage life well in magical world, feels "out of place" and uncertain she can cope, even after spending several years in Hogsmeade. Ind gave th "tips" on managing house elf, reports that he learned these from murdered friend. During disc[ussion], ind became animated, brief smiles, able to answer questions in near-normal tone of voice. Th prompted ind to describe murdered friend, tell th about "best time" they shared. Ind able to describe school pranks, including wandering school grounds illegally by night. Ind laughing softly at points in tale, became unselfconscious. Th wondered aloud what happens to dead friend's experience, wisdom, funny stories, if ind not keeping them alive, as dead man's son too young to remember father. Ind slammed cup on table, rose quickly, strode out silently. Suicide Assessment: no means, no plan, no history of attempts. Ind reports no desire to harm self at this time. Risk low.

Plan: Help ind to reduce depressive sxs as possible. Help ind see value of his own status as survivor.

Personal Journal, July 15, 1996

Well, I got RL to storm out this afternoon. Damnitude. Okay, he was leaving therapy anyway; I had to try something.

Anyway, I pray to heaven that I never have to write another Progress Note that includes casual references to "the Dark Lord" and "Battles at the Ministry of Magic." My reality is getting too shaken. But let's face it: if I am not writing such things in notes about RL, I'll eventually be writing them in notes about somebody. After all, we are taking sides for a war here. Geeze, therapy in the blissfully ignorant Muggle world was so much less complicated.

Communication (included in chart July 17, 1996)

[Handwritten note by owl]

Can I talk to you before the 22^nd? If I offer to make the tea?

RL

PS. I could not get through via your fireplace. Is it blocked somehow?

PPS. Has the deranged house elf realized yet that the old C. cottage has no basement?

Communication (included in chart July 17, 1996)

[owl to ind]

Please come tomorrow afternoon at 4, if possible. Happy to see you.

G Walker

PS. I think the elf firmed up the chimney clog just after she finished searching for the stairs to the basement. Can you help?

Session 4: July 18, 1996

Goals: Reduce depressive sxs aeb ind will identify his remaining support group and practice telling them his feelings. Ind will create and work on schedule of appro eating and sleeping habits.

Sxs: Low mood, lasting previous 2 years, parallel w/ significant losses in personal life. Chronic illness [unspecified], resulting in periodic weakness, loss in physical strength. Currently unemployed, lives on small income. Reduced eating, sleeping patterns, some weight loss. Withdrawal from social group. Trust issues w/ th.

Interventions & Response: Ind avoided speech w/ th, rushed thru kitchen, making tea, chattering lightly re: irrelevant topics. Tea in study, where ind examined fireplace, described it as "completely bollixed up." Ind located house elf, sent th w/ tea cup from study. Sounds of banging from study. Ind invited th to return to study; no elf present. Ind announced that he'd "tossed her out the window until she learns some manners." Unclear if joking. Th sat w/ ind in silence. Ind babbled on irrelevant topics. After 2 cups tea, ind expressed irritation, asked, "Aren't we going to do therapy?" Th replied, "It's your knut." Ind repeated demand. Th kept voice low, replied, "When you decide to stop fixing my world and start taking risks in therapy again." Ind openly angry, slammed fist on table, declared loudly that he will not be "walking memory book" for murdered friend's son, as th suggested prev visit, declared he has to have more purpose to life & has right to plan life based on his own needs. Ind reports that he "only came back to set th straight" on this matter. Th gently confronted ind re: reasons ind said totally different things in note, fixed th's home, before "getting down to business." Ind retorted that he is "not intolerably rude like you Yankees." Th quietly asked if ind referring to Muggle Yankees or Magical Yankees, or was th's nationality alone enough to rouse ind's prejudices? Ind's mouth dropped open. Th advised ind that he would be welcome back to therapy when he describes his current medical condition to her and when he decides to work on figuring out just who he wants to be, if he's done being "Mr. Fixit." Th advised ind that he does not need to earn th's approval or caring. For coming to th for therapy, he gets both by default anyway. Th gently removed teacup from ind's hand and left study.

Suicide Assessment: no means, no plan, no history of attempts. Ind reports no desire to harm self at this time. Risk low.

Plan: Help ind to reduce depressive sxs as possible. Help ind see value of his own status as survivor.

Communication (included in chart July 18, 1996)

[Handwritten note by owl]

I apologize. Can I come the 22^nd? Can I still make the tea?

RL

Communication (included in chart July 18, 1996)

[owl to ind]

Happy to see you, regardless. No apologies needed. Welcome to Real Therapy. Please review section of contract for therapy we mutually signed in first meeting, wherein you agree that "there are no guarantees in therapy; patient may feel worse before feeling better."

G Walker

PS. I screwed up. I asked you to help me with the chimney. It was not you just throwing yourself into my home as "Mr. Fixit." Humblest apologies.

PPS. I need you to know that I make darned fine tea, for a Yank.

Session 4: July 22, 1996

Goals: Reduce depressive sxs aeb ind will identify his remaining support group and practice telling them his feelings. Ind will create and work on schedule of appro eating and sleeping habits.

Sxs: Low mood, lasting previous 2 years, parallel w/ significant losses in personal life. Lycanthropy, controlled by strong medication/potion, resulting in periodic weakness, loss in physical strength. Currently unemployed, lives on small income. Reduced eating, sleeping patterns, some weight loss. Withdrawal from social group.

Interventions & Response: Ind entered, made solid eye contact w/ th silently, made tea in kitchen, chattering lightly re: how th can use fireplace, instead of rental owls "which cost too much, in my well-informed and highly British opinion." Tea in study, where ind examined fireplace, described it as "blocked up again." Ind observed that th should not feel forced to keep "demented and unsuitable house elf, therapy or no therapy." Th reported that she likes "mad things about the place, to keep my hand in." Ind laughed, said she had found the right patient in him, then. Ind displayed photos of dead friends to th, including one of murdered couple and infant son. Ind's voice broke several times while describing events of photos. Th prompted ind to tell stories of happy events w/ friends. Ind asked if he "allowed" to include happy stories involving friend who went over to Dark Lord. Th agreed, wondered why ind even felt need to ask. Ind admitted to guilt that he felt grief for traitorous friend, could understand that friend is "weak", admitted that he had once tried to kill friend, still angry enough to do this, as "the war is just that desperate." Ind admitted to conflicted feelings, due to fears that he, too, is "weakling at heart." Th attempted to normalize feeling, stated that everyone fears same thing about themselves. Ind brushed off th's words. Th asked what ind would have done, if, instead of "weak friend", he had been approached by Dark Lord 15 yrs previously. W/o hesitation, ind replied, "I would have died for James and Lily." Th expressed confusion, as this is not answer of "weakling." Ind silent, then said his "weakness" is being "too needy" for friends, not standing up at right times to friends. Th asked why ind needs friends so desperately. Ind silent for long time, pursed lips, stared around room, avoided th's eyes. Th suggested that whatever ind wanted to tell th, he should tell her bec it would help him in therapy, not make th like him more. Ind explained to th that he is werewolf. Ind explained lifestyle resulting from condition, including medication/potion dependence, fears that he has hurt people when "changed", inability to keep employment. Ind challenged th in bitter voice to tell him "how you like me now." Th explained quietly that ind is first werewolf th has met; she has no idea how to think about his situation and would require ind to help her understand his needs, based on having chronic disease that some people react to in strongly rejecting manner. Th asked ind's permission to research lycanthropy before next meeting. Ind agreed, seemed dazed. Th thanked ind for trusting her w/ his fears. Suicide Assessment: no means, no plan, no history of attempts. Ind reports no desire to harm self at this time. Risk low.

Plan: Help ind to reduce depressive sxs as possible. Help ind see value of his own status as survivor.

Communication (included in chart July 22, 1996)

[Owl to Augustus Pye, Trainee Healer, St. Mungo's]

Need magical healer info from Trusty Source. Lacking that, can you point me to info re: lycanthropy?

Cheers,

Gemma W.

Communication (included in chart July 23, 1996)

[Handwritten note & scroll by owl]

Cf. Fantastic Beasts and Where to Find Them by Newt Scamander.

Relevant excerpts attached. Here's my favorite: "At one point, the Werewolf Registry and Werewolf Capture Unit were both in the Beast Division, while at the same time the office for Werewolf Support Services was in the Being Division."

You can imagine how much fun we all have at St. M's, trying to help people newly bitten, as there's still no clear policy on what we non-lycanthropes actually are supposed to do with them--help them or start molding silver bullets. G'luck.

Gus P.

PS. Congrats that he actually told you. When I referred him, he swore himself blue that you "couldn't make him talk". I told him that I was sending him to an American therapist because he speaks like a bad version of an American gangster film, so you might be able to help him at least cure that.

PPS. Are you aware that your floo access is blocked? Been trying to get through for hours, then gave up and rousted out my supervisor's old owl. Toss her a treat before you send back your fervent thanks, will you please? Can't believe old BC let that happen to his holiday place. You need to keep up appearances, Old Girl, now that you are the Proud Owner. Do fix it. Owls can get pricey for Trainees who don't keep their own, you know.

Change of Diagnosis, July 23, 1996:

Former Diagnosis:

Axis 1: Major Depressive Disorder

Axis 2: Dx[diagnosis] deferred

Axis 3: Unspecified chronic illness, reported to "run in monthly cycles", leads to periodic weakness, apathy

Axis 4: Significant recent losses among primary support group. Low income. Chronic illness.

Axis 5: 61

Revised Diagnosis:

Axis 1: Major Depressive Disorder

Axis 2: Dx deferred

Axis 3:Lycanthropy, leads to periodic weakness, apathy

Axis 4: Significant recent losses among primary support group. Low income. Chronic illness.

Axis 5: 61

Rationale: Ind reports pre-existing condition, i.e. Lycanthropy, in session of 7/22/96. St Mungo's Trainee Healer, Augustus Pye, confirms Dx.

Personal Process Note, July 23, 1996

A werewolf? A werewolf? At least I am safe by day, but we'll have to be careful with those late afternoon sessions in winter, if there's a full moon lurking and it gets dark early.

A werewolf? Did Harry ever tell me this part? Could he have told me and I just forgot? Of course that's what must have happened. After all, with Harry, it's always all about his pals at school and Sirius-this and Sirius-that.

And did Fearless know about this? How did she find out? Now she stomps around, muttering "Filthy werewolf befouls tea things. Filthy werewolf never allowed in house with proper Mistress." I finally lost it with her this morning and snarled, "Filthy werewolf knows how to get tea in pot and make it taste good. Filthy werewolf knows how to clean fireplace and chimney."

It's been mighty quiet in the kitchen ever since. A little too quiet, I suspect...

Communication (included in chart July 25, 1996)

[Handwritten note by owl]

Suspense is killing me. Promise no fleas in tea, if allowed to come on 29^th.

RL

Communication (included in chart July 25, 1996)

[owl to ind]

Welcome on 29^th, usual time. Will need help selecting appropriate [i.e cheap] owl, as no hope of ever getting floo permanently unstuck. Fleas no problem; good protein source if aimed into full cup of tea. Tastier than most British cooking anyway.

Gemma W

Communication (included in chart July 26, 1996)

[Handwritten note by owl]

Have heard house elf is tender. If needed, could roast in (permanently) repaired fireplace. See you on 29^th.

RL

Communication (included in chart July 25, 1996)

[owl to ind]

Forced to eat your last, as elf watches incoming mail. Tastier than most British cooking anyway. Feel free to make flea--I mean, tea.

Gemma W