Shirah Vollmer MD

The Musings of Dr. Vollmer

Publishin’

Posted by Dr. Vollmer on April 22, 2014

I am still on hiatus, but check out my panic attacks commentary…

 

 

http://www.hcplive.com/publications/family-practice-recertification/2014/April2014/How-to-Distinguish-Panic-Disorder-from-Panic-Attacks

Posted in Anxiety, Panic Attacks | Leave a Comment »

Hiatus!

Posted by Dr. Vollmer on March 27, 2014

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Injustice

Posted by Dr. Vollmer on March 26, 2014

 

Also….http://onpoint.wbur.org/2014/03/20/prison-reform-america-holder-obama

 

“We have a system of justice in this country that treats you much better if you’re rich and guilty than if you’re poor and innocent. Wealth, not culpability, shapes outcomes. And yet, we seem to be very comfortable. The politics of fear and anger have made us believe that these are problems that are not our problems. We’ve been disconnected.”

 

Bryan Stevenson is my hero today. http://en.wikipedia.org/wiki/Bryan_Stevenson ” He spoke at TED2012 in Long Beach, California, and received the strongest standing ovation ever seen at TED.[3] Following his presentation, over $1 million was raised by attendees to fund a campaign run by Stevenson to end the practice of putting children in adult jails and prisons. [4]” 

 

He is a new hero for me, as I was not familiar with him until I popped into the TED radio hour, leaving his presentation with such sadness about our, the United States, society. “We love innovation. We love technology. We love creativity. We love entertainment. But ultimately, those realities are shadowed by suffering,abuse, degradation, marginalization. And for me, it becomes necessary to integrate the two. Because ultimately we are talking about a need to be more hopeful, more committed, more dedicated to the basic challenges of living in a complex world. And for me that means spending time thinking and talking about the poor, the disadvantaged, those who will never get to TED. But thinking about them in a way that is integrated in our own lives.”

“And as I was walking up the steps of this courthouse, there was an older black man who was the janitor in this courthouse. When this man saw me, he came over to me and he said, “Who are you?” I said, “I’m a lawyer.” He said, “You’re a lawyer?” I said, “Yes, sir.” And this man came over to me and he hugged me. And he whispered in my ear. He said, “I’m so proud of you.” And I have to tell you, it was energizing. It connected deeply with something in me about identity, about the capacity of every person to contribute to a community, to a perspective that is hopeful.”

It is so easy to deny the suffering of others, or to think that those who suffer deserve their pain. The higher road is to feel that vulnerability, that sense that we share a civilization that without the privilege of love, education, support and the absence of trauma, we can easily slip into despair and aggression, both outward and inward. This message hearkens back to my post about Adam Lanza. His aggression is not surprising, but rather it reminds us of how tragedy begets tragedy. His personal tragedy of not being able to find mental peace spilled over into the tragedy of his father, Peter Lanza, who has to live with his son’s notorious legacy, and the tragedy in each family who suffered the shocking loss of their innocent loved one. Suffering is our common bond. It reminds us that the world needs to help one another diminish suffering, rather than separate ourselves from the pain of others. This separation creates the inequality gap, the opportunity gap, and most importantly the emotional gap because we lose touch with our own layers of despair and hopelessness which creep in from time to time. Understanding these common feelings brings us together as a society. Splitting off these feelings creates a shallow existence, where, as Bryan Stevenson says, “that we cannot be full evolved human beings until we care about human rights and basic dignity. That all of our survival is tied to the survival of everyone. ” No wonder he got the largest standing ovation in TED history. He needed to remind us that we easily go into denial, to our own detriment.

Posted in Criminal Justice, Musings | 1 Comment »

NYer Cartoon

Posted by Dr. Vollmer on March 24, 2014

 

Starbucks is changing its demographic.

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Past Exploration-Value or Vapid?

Posted by Dr. Vollmer on March 21, 2014

TED2014_RL_DSC_4240_1920

http://www.nytimes.com/2014/03/21/opinion/brooks-going-home-again.html?emc=eta1&_r=0

 

“Historical consciousness has a fullness of paradox that future imagination cannot match. “

“Sting’s talk was a reminder to go forward with a backward glance, to go one layer down into self and then after self-confrontation, to leap forward out of self. History is filled with revivals, led by people who were reinvigorated for the future by a reckoning with the past.”

 

“The past is the past,” Sofie, a thirty-three year old, recently divorced, mother of three says, to dismiss my inquiry into her prior relationships. So, this article about Sting hooking into his creativity through the beauty of a narrative thread, reminds me how to help Sofie to allow exploration both of her remembered past and her imagined future. Together, along with her present state of mind, all coalesce into a sense of internal stability, even in the midst of external instability. “Narrative order” are the words that Mr. Brooks uses to explain the human need to understand how their past influences their future and how their future, also influences how they view their past. Do they create a story of success over failure or a story of one failure after another. The stitching together of one’s life’s story varies with mood, current circumstance and audience. “Maybe the past, at this moment, seems so unpleasant,” I say, highlighting that Sofie’s abrupt response to my inquiry suggests that she needs to protect herself from the feelings which might arise when exploring her past relationships. At the same time, such inquiry will give her the strength to move forward during this very challenging time.

As David Brooks says,

“The person going back home has to invent a coherent tradition out of discrete moments and tease out future implications. He has to see the world with two sets of eyes: the eyes of his own childhood self and the eyes of his current adult self. He has to circle back deeper inside and see parts of himself that were more exposed then than now. No wonder the process of going home again can be so catalyzing.”

See also…http://blog.ted.com/2014/03/18/were-all-in-the-same-boat-sting-at-ted2014/

Posted in Psychotherapy | 1 Comment »

Introducing My Twitter Button!

Posted by Dr. Vollmer on March 21, 2014

Extending my range. You will notice at the end of my posts, you may now post to twitter. I know that not all of you are tweeters, but for those of you who are, check it out. I am debating how active I want to be on twitter, so this is my first step into that microblogging world. As with all change, I have both excitement and fear. So far, civilized discourse has dominated my experience of blogging, much to my relief. I can express my ideas, however clumsily, and a discussion can ensue. Now, I am reaching further. I have a Facebook button too! Let’s see what happens.

Posted in Media Consumption | 3 Comments »

Cliches

Posted by Dr. Vollmer on March 20, 2014

Cliche as a defense is my topic this morning. Lapsing into clichés’ often gives people the opportunity to hide behind more difficult, more complicated and more nuanced experiences. Byron, sixty-four, was recently diagnosed with a catastrophic diagnosis, in which he was told he has about eight years to live, in which he will likely experience a  deteriorating mental course. He is upset, devastated, yet to maintain his always pleasant demeanor, he speaks in clichés. “I need to live each day. Carpe Diem. I am so happy I am alive.” He says with complete sincerity, but with a tone of falsehood and denial about his fear and profound feeling about the unfairness of life. “If I am to be honest about how I feel, I will be Negative Nancy,” he says, as if he has no choice other than to lapse into clichés. “Yes, but when you are here, and we are together, you do not need to put on your pleasant demeanor for me. I suspect that you are so polished with your clichés, that you do not give yourself the opportunity, even with me, to be honest with your experience.” I say, highlighting that although I understand he wants to maintain relationships by avoiding negativity, at the same time, he loses touch with his internal process. “There are many truths,” Byron tells me, again, a cliché, I think to myself. “Yes, but I do not know your many truths,” I say, reminding him that he hides behind these over-used mantras. “I am not ready to know my truths,” Byron says with uncharacteristic refusal. “When you are ready, we can go there,” I remind him. “Yes, but some truths are better not known,” he argues. “And some truths seem to be better not known, but when known, are less terrible than imagined. Name it to tame it,” I say, “yes, that is a cliché,” I needlessly remind him.

Posted in Psychotherapy | 4 Comments »

Debilitating Fatigue

Posted by Dr. Vollmer on March 19, 2014

Wyatt, fifty-three, comes in complaining of “debilitating fatigue.” He sleeps fine, and consistently, and yet, he never feels like he has enough energy. A medical work-up proved negative, meaning there was no obvious medical explanation for his, what he experiences, as a sudden free-fall into “no energy.” “Tell me about your life,” I say, trying to understand the complexity to his fatigue. Certainly, medical problems are still on my mind, but at the same time, I wonder about his fatigue as an unconscious manifestation of his psychological stress. “Well, I am getting a divorce. I am really unhappy that I won’t see my kids, as much, but that has gone on for six months now.” He says, as if six months is a long time. “Maybe now it is hitting you in a new way,” I say, suggesting that the journey of adjustment is a long process. “That is possible,” Wyatt says, in a way in which he feels open, but reluctant to accept a psychological explanation for his fatigue. Fatigue, like a fever, is the point of inquiry, both medical and psychological, in which the mystery begins. Like the Malaysian Airlines plane disappearing, so too, Wyatt’s fatigue presents more questions than answers. Moving away from binary thinking is the key. Many factors could be at play, creating a perfect storm of mental distress. As long as Wyatt and I can stay in a place of curiosity, we can begin to explore together, possibilities which might illuminate factors which go into his “sudden free-fall.” As with all kinds of disturbances, the fatigue then causes secondary issues of depression and hopelessness. The spiral goes down, giving us the challenge of making a 180. Exercise, diet, and meditation are all positive suggestions, but our focus is motivation. Wyatt needs to see there is light at the end of his fatigue. Working together helps give him the hope and discipline to keep focusing on his fatigue, until it goes away. I do not long how long it will take, but I do know that we are in it together until the spiral turns.

Posted in Psychotherapy | 2 Comments »

Does ‘Ecstasy’ Live Up To It’s Name?

Posted by Dr. Vollmer on March 17, 2014

MDMA

http://www.latimes.com/local/la-me-mdma-20140316,0,4729638.story#axzz2wFf3Afb4

“By some estimates, as many as 4,000 therapists were using MDMA in their practices before federal authorities banned the drug.”

MDMA, the active ingredient in Ecstasy, heals the traumatized brain, or so some patients and therapists believe. No science exists, only anecdotes. Is it compassionate to try a compound in which the stories sound compelling, even though it is illegal? This is the dilemma posed by this article which grabbed my attention both because of the ethical dilemma, and the intriguing neurochemistry. Let me start with the latter. Can we imagine a chemical which makes traumatic memories, memories from war-torn environments, memories from childhood sexual abuse, somehow seem less shameful and more open to discussion? Yes, I can imagine that. I can see how if the amygdala is suppressed, then the sting, if you will, of the memory is diminished, and thereby a narrative can flow without the obstruction of judgment or horror. As to the ethical dilemma, this is more troubling to me. Both sides of the dilemma make sense. On the one hand, people who are suffering need relief, and sometimes we have to think out of the box to obtain that. On the other hand, science is critical to advancement and so we should advocate for meticulous research before walking into territory which could cause more harm than good. Yes, it is true, that my professors did LSD research on autistic children, to see if the LSD would help with social skills, and so using illicit drugs for medicinal purposes is not a new idea. Yet, these professors used government funding to explore, what turned out to be, a failed experiment. For the clinician to advise MDMA ingestion, without the rigors of a clinical trial strikes me as well-intention, but misguided. The seduction that a medicine or a diet can alleviate human suffering creates an industry of hope and opportunity. If there were no side effects, like our relatively new gluten-free fad, then I am happy to emphasize the lack of science and encourage people to have their own trial. However, in the case of MDMA, fooling around with brain chemistry is a very scary proposition. I am waiting for the science, even though, as the article reminds us, no one seems to want to fund this. Having said that, I would rather use our current tools than to step over that anecdotal line which says,  “well, it worked for me, and so it might work for you too.” Ecstasy, the drug, in my clinical experience, is a wish for some, true for others, and a nightmare for the rest of the folks. I repeat. I am waiting for good data.

See also ……

Flashback to the 1960s: LSD in the treatment of autism.

Abstract

Between 1959 and 1974, several groups of researchers issued reports on the use of d-Lysergic Acid Diethylamide (LSD) in the treatment of children with autism. This paper reviews that literature to consider how the authors justified these studies, as well as their methods, results, and conclusions. The justification for using LSD was often based on the default logic that other treatment efforts had failed. Several positive outcomes were reported with the use of LSD, but most of these studies lacked proper experimental controls and presented largely narrative/descriptive data. Today there is renewed interest in the use of psychedelic drugs for therapeutic purposes. While this resurgence of research has not yet included children with autism, this review of the LSD studies from the 1960s and 1970s offers important lessons for future efforts to evaluate new or controversial treatments for children with autism.

PMID:

 

17608329

 

[PubMed - indexed for MEDLINE]

Posted in Autism, Psychobiology, PTSD, Substance Abuse | 2 Comments »

NYer Cartoon Entry

Posted by Dr. Vollmer on March 17, 2014

I hope she does not mess up her uterus.

 

http://www.sfgate.com/technology/businessinsider/article/The-Outrageous-Reason-Why-Women-s-Ski-Jumping-Was-5127901.php

Posted in Cartoons | 1 Comment »

 
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