Shirah Vollmer MD

The Musings of Dr. Vollmer

Manic Defense: The House of Cards

Posted by Dr. Vollmer on December 7, 2011

Mai, fifty-four, came in looking unusually fashionable and trim. Her make-up was more than usual, tastefully done. She was smiling and bubbly, outside of her usual down demeanor. “I just came back from Puerto Vallarta and I feel great. It was a great trip. I feel like a new person,” she tells me with great enthusiasm and excitement. “It was nice to get out of your routine,” I say. “And it was nice to get away from my family,” she quickly responded. “That suggests that your family brings you down in some ways, such that when you settle back into your routine here, then you might return to your down feelings. Although your good feelings are wonderful to have, I wonder if they are a house of cards, bound to fall down with a slight wind.” I say, knowing that my comment could be interpreted as being negative, but hoping that she will see that the stronger her coping skills become, and the more honest she is about her life, the more she will be able to sustain these good feelings. “I realize that when I was away I let myself do things that I don’t let myself do here. I would never wear skirts here because I don’t like the way my legs look, but in Mexico I felt free to wear skirts and not care about my ugly calves.” Mai says with deep seriousness. “It is almost like you gave yourself a different rule book in Mexico which freed you up to be more relaxed about yourself and your body,” I say. “So what should I do?” Mai asks me, thinking that I won’t answer her question. “Burn your rule book,” I say, “with a ceremony so you have witnesses that you are going to give yourself more permission to be yourself, despite what you perceive are the outside pressures to be a certain way.” Mai laughs. “OK, when I have my holiday party, I will burn my book. That’s a deal.” She says with uncharacteristic good cheer and lightheartedness. We will see what the holidays bring. I hope the wind does not blow too hard for Mai.

9 Responses to “Manic Defense: The House of Cards”

  1. Shelly said

    Is your fictional account about a patient with manic-depression, or about someone who feels freed upon vacation and inhibited in real life? Don’t we all feel that way when we are put in separated from our families and are in different environments and nobody knows us? Don’t we “let go” of our inhibitions a bit and pull off our masks? How can we “burn the rule books” when we come back to earth and return to our real lives and reality, our commitments, routines and families? Perhaps I didn’t really understand the essence of this piece: for if you were describing manic-depression, then indeed, I perfectly understand that Mia’s house of cards will soon come crashing down.

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    • My fictional account is the latter, someone freed up and inhibited in her routine life. Vacations do different things for different people during different times of their lives. Some people give themselves permission on vacation to be more free, whereas others feel bound to use their vacation to maximize their exposure to a new and interesting place. My point is to understand how we constrict ourselves with our rules, often unknowingly. I am trying to describe a manic defense which is indeed very different than the old term manic-depressive illness. The manic defense is an enthusiastic way of being which is bound to be temporary as it does not fix the underlying issues of unsatisfying relationships and interactions. I should write more about this, as this is a very layered subject. Thanks.

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  2. natasha said

    Hi i was diagnosed with manic defence yesterday can you tell me what it is and is it an illness or disorder thankyou natasha

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    • Hi Natasha,
      Of course, I do not have the context, but generally speaking a manic defense implies that you are actively engaged with a multitude of activities so as not to focus on your psychological pain. SV

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      • natasha said

        Thankyou so much for your reply Dr Vollmer I think i understand it now but am sure that it does not describe me as i tend to go to pieces when problems arise i dont keep busy i completely clam up does that fit ? regards Natasha and Thankyou again

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