Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for December, 2010

My Advice for 2011

Posted by Dr. Vollmer on December 30, 2010

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Mother Transference

Posted by Dr. Vollmer on December 29, 2010

 

   Ray, sixty-five, was excited when his best friend, Lee, sixty, married Lizzie, age forty, because for the first time in his life, Ray felt he had found a mother figure. As in my previous post,  https://shirahvollmermd.wordpress.com/2010/03/30/mother-figure/, this transference, or these feelings of Lizzie being motherly to Ray were unconscious. Ray would call Lizzie to tell her about his “accomplishments” but he would never ask how Lizzie was doing. Lizzie reports to me “it was as if Ray wanted me to pat him on the back for cleaning his room. I felt foolish, like this was a relationship that was really uncomfortable for me, but really important to Ray.” Lizzie reports her feelings about Ray with anguish and uncertainty. “Maybe Ray needs someone to watch over him and he feels that you are really interested in him in a motherly sort of way.” I say, thinking about how one’s need for a mother never really goes away, and maybe we all do what Ray is doing with certain friends, although in a less obvious way. “Yes, but I don’t want to be Ray’s mother,” Lizzie says in loud protest, as if  fighting off this notion is a way of saving her soul. “I am curious,” I say, “what is so terrible about being motherly to Ray?” I ask, thinking that I probably know the answer, but I am curious how Lizzie will respond to my question. “I want to have friends with mutuality. I have kids. I don’t need any more. I want to spend my time with people where there is a give and take to the relationship, not, as I do with Ray, just listening to him report to me his strides since our last conversation.” Lizzie says with despair and disappointment, as if she hoped that marrying Lee would expand her social network, but over time, she has discovered that Lee’s social connections, which mostly consists of Ray, does not  suit her well. “Do you think that if you don’t respond to Ray in a maternal way, then maybe Ray will interact with you in a different way which might be more satisfying?” I ask, thinking that Lizzie may be encouraging Ray’s mother transference, and as such, Lizzie’s change in her behavior towards Ray may solve her problem. “Oh, I have tried that,” Lizzie says, continuing her despairing tone. “In fact,” she continues, “Ray told me that I would be really interested in a story he wanted to tell me, and I cut him off and said, well, actually, maybe I am not as interested as you think. I thought I was being harsh, but I also wanted to let him know that I did not want to be a ‘dear diary’ for him.” “How did he respond?” I asked. “Well, he just moved on, as if I did not hurt his feelings, but I felt like I did.” Lizzie reports, claiming that he knows Ray better than Ray knows himself. I thought that could very well be true. “You and Ray are engaged in a deeply unconscious relationship and it sounds like you are aware that this relationship is not healthy for you because it is so one-sided.” I say, trying to help Lizzie cope with her mixed feelings of wanting to make Lee happy by getting along with Ray, but at the same time, wanting relationships which feel growth promoting and mutual. “Yes,” Lizzie declares. I feel like Ray is our child and if I pull back, then both Ray and Lee will be hurt.” “That is interesting,” I say. “Maybe if you talked about your feelings towards Ray with Lee, he would understand.” “Right,” Lizzie says, “I need to do that. “I am glad that Lee does not treat me like his mother; that would be really bad.” Lizzie says, taking our conversation in a new direction. “It sounds like you allow people to use you as a ‘mother figure’ because you are willing to listen to them and not insert your own ideas when they are talking.” I say, stating that Lizzie’s good listening skills might be a liability when it comes to her relationship with Ray. “I never thought of it that way,” Lizzie says. “I just think it is rude to interrupt.” “Well, usually it is, but sometimes you have to steer the conversation away from a mother/child interaction.” I say, helping Lizzie navigate the waters of social interactions and civility. “That is interesting,” Lizzie says. “Maybe I will learn to abruptly change the subject, even though I hate when other people do that to me.” “Well, yes, sometimes you have to use a crude instrument to change course,” I say.

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2011

Posted by Dr. Vollmer on December 28, 2010

   January 1, 2011, a focal point for weight loss, exercising more and spending more time with your family, in that the turning of the calendar creates hope for renewal.   As with my earlier post, https://shirahvollmermd.wordpress.com/2010/01/24/new-years-resolutions-a-psychoanalytic-perspective/, this is the time of year where one can pretend that “those things are now behind me,” as Leslie, forty-one, said referring to the fact that 2010 for her represented the ending of a very painful four-year relationship. I use the word pretend because January 1st does not make the pain of Leslie’s relationship any less than it was on December 31, and yet, the changing of the calendar supports this notion of a before and after experience. The human mind, with all of its complexity, seems to need to reduce the emotional interior to a simpler notion of an empty slate. The fantasy that we can start again, be it a new job, a new school, a new relationship, contradicts our understanding that we take ourselves with us wherever we go and as such, the past lives in the present. The confluence of past, present and future, all relevant in any given moment, creates anxieties and tension. Eliminating the past, or the wish to do that, can temporarily minimize anxiety, but at the cost of mental shallowness. Embracing the past, however painful, allows for a deepness of thought, a compassion for others, and an acceptance of oneself. So, as the calendar turns, I want to remember the past, be excited about the future, and embrace the moment. Indeed, that is my hope for all.

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Home From College

Posted by Dr. Vollmer on December 27, 2010

     Fran, twenty, a junior at a state college, out-of-state, a patient of mine I have not seen since she was fifteen, calls me because she wants to come in to “chat about college.” . I am excited to see her. I begin to remember all of our previous “chats” and I wonder how time, maturity, and college have changed things. I also wonder why now? What is going on at this moment, that makes her want to come in? At the same time, I feel the tug that winter break is short, so I wonder what happens if we need to continue to “chat”. Of course, we could “chat” by telephone or Skype, but face to face always seems the most meaningful to me.

   Fran has a big smile on her face as I open the waiting room door. She seems so happy to see me; I make a mental note of that . “Everything is fine,” she opens the session with a breezy feeling. “I am happy to hear that, ” I say, wondering what is on her mind; still wondering what made her call me when she did. “How is school?” I ask, attempting to re-open our relationship. “Fine” she says again. “I have not seen you for a while, how have you been with regards to your medication?” I ask, since Fran took stimulants on and off throughout high school for her ADHD. “Oh, I have not needed any in college. Actually, that is not true, my friends give it to me when I need to study.” Fran says with little shame or fear of my response. “You might be better off with a prescription, since that might be more specific to your needs,” I say, without coming down too harsh, but also letting her know that sharing stimulants, although common in college, is illegal. “Yea, I know, maybe we can talk about that at the end,” she says, now with a heavy tone, as if she has a very specific purpose for being in my office. “Sure, I say, what’s on your mind?” I ask. “Well, I just feel so lost. I don’t know what I want to do with my life. Other people seem to have a direction, but I am really clueless.” Fran says with pain and despair. “What is your major?” I ask, thinking that she had to find a focus, so maybe that is a sign of her academic passion. “Psychology” she says, as if that does not really count as a major. “Maybe you are interested in the human mind, and maybe that gives you a focus,” I say, stating the obvious, but wondering how she will respond. “Yea, I am interested in that, but I am just not sure where to take it,” Fran says, continuing her tone of despair. “It seems like you are uncertain about your future and that uncertainty is making you terribly anxious,” I say, again wondering how she will hear that. “Yes, that is it. I just can’t stop being anxious about it,” she says, feeling pressured as if she has to plan for her future today. “Maybe we can use some time over your winter break to explore how you are thinking about your life and maybe that will help you calm down about your future so that you can think more clearly,” I say, explaining to Fran that her vacation is an opportunity for self-exploration. “I would really like that,” Fran says, with conviction. We have reconnected, I feel.

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Black Swan: A Psychoanalytic Perspective

Posted by Dr. Vollmer on December 20, 2010

   Neena (Natalie Portman) is a perfectionist. She is obsessive, determined,  and focused. At the same time, she is emotionally constricted, as if she is barely holding herself together despite feeling  both unloved and unloveable. This is a dark movie, as the title ‘Black Swan’ suggests. Neena is that tragic combination of enormous talent combined with a gaping internal hole. Success, of course, only makes the hole worse, as she struggles with her external accolades juxtaposed with her internal emptiness. Neena is Winnicott’s classic tale of a false self, a self the world sees and admires, but does not ring true with her true self of despair and anguish. Most interesting to me, Neena’s mother, is also an empty shell; a woman who appears to have transmitted her emptiness to the next generation. This intergenerational tragedy runs so deep, it is hard to walk out of the movie with any hope for humanity. ‘Black Swan’ is a feel-bad movie; a movie which reminds us of the darkness of human existence. This is a movie that reinforces the disparity between the external and the internal worlds; this is a movie that shows, powerfully shows, that without internal strength, without self-love, life is robotic, lifeless. The movie is well done, but depressing. To love, to feel loved, is vital. ‘Black Swan’ showed us that in a black way.

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‘Race to Nowhere’: A Commentary

Posted by Dr. Vollmer on December 17, 2010

http://www.youtube.com/watch?feature=player_embedded&v=hbq6Cr1AQ7A#t=0s . This is a film about raising children in a demanding society in which the pressures of school seem to cause parents to lose sight of the value of being a child, acting like a child, playing like a child, and enjoying friends like a child. Instead, parents fret about grades, test scores and colleges. As a result, children feel the pressure to perform,  and this pressure often leads to stomaches, headaches, constant teariness and, according to this movie, at least one tragic suicide of a fourteen year old girl. As a child psychiatrist, I was taken aback that no psychiatrist was interviewed for this film. Sure, there were professionals interviewed:  a pediatrician, a psychologist, and  a professor of education, but where was the child psychiatrist? I wonder why a film about child mental health does not seek advice from one of my colleagues, or from me, for that matter. Is it that all experts are alike and as such, a pediatrician’s point of view is the same as a child psychiatrist? Is it a contempt for my field which has been known to see the negative behaviors of children, such that we do not focus enough on resiliency? I am not sure.

     “Race to Nowhere” is an unfair title. Children are pressured to get into well respected colleges because a highly regarded education gives a person an advantage in the job market. This seems to be true. On the other hand, the price to pay, the mental stress on the child, may not be worth the effort. It is this nuance which was lost in the film. Some pressure is good, and useful to help a child thrive in the world. Too much pressure leads to a disintegration of the child’s ego. Finding that delicate balance is the key to good parenting. The movie missed that point, as it tried to do the ‘ one size fits all’ to parenting in the twenty-first century.  That some kids crumble under the pressure, speaks to the idea that a parent has to monitor his child for signs of distress. Some kids are thriving under the pressure; the movie did not mention that. These thriving kids are reaching personal goals that they never felt to be possible because they are exposed to such a variety of activities and challenges. Society is changing to a faster, more demanding, and more technological experience. Helping our children adapt to those changes is the goal. The movie would make you think we have to slow society down so that our children can cope better. I would say that we have to take our new environment and help our children adapt to it  in a way that makes sense for them individually. If there is a sequel, I would  gladly recommend a child psychiatrist who can speak to this issue; I would be happy to  be included.

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Families At the Holidays

Posted by Dr. Vollmer on December 16, 2010

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The King’s Speech: A Psychoanalytic Movie

Posted by Dr. Vollmer on December 15, 2010

The King’s Speech, predictably demonstrates the power of an asymmetrical relationship, where one person who  is confident, skilled and determined is matched up with another person  who is vulnerable, but at the same time determined to change his life. Through hard work, nonlinear progression (a lot of back and forth), and an evolving loving relationship, King George VI  overcomes his biologically and psychosocially based stammer. First, the rules are set down; five times a week or nothing. The place is fixed-Lionel’s office. Then, the goal, so poetically, is to give “Bertie” as Lionel calls him a “voice”. In the concrete sense, Bertie had a voice, but in the psychoanalytic  sense, he did not. He did not understand his own personal power. By helping Bertie connect with his inner strength, Lionel gives Bertie a voice. In return, Bertie gives Lionel gratitude. The asymmetrical relationship over time becomes more symmetrical. The relationship “cured” Bertie of his personal anxieties which exacerbated his genetically determined stammer. With Lionel’s help, Bertie could use other parts of his brain to control his defective areas, his stammer. In so doing, Bertie took control of his voice. His love of Lionel was the key to this development. The King’s Speech demonstrates  psychoanalytic  principles. It is a nice advertisement.

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The Recurring Dream

Posted by Dr. Vollmer on December 14, 2010

     Maryann, fifty-five, married with three grown children, says with horrible distress in her voice, “I had this dream last night. I think I have had this dream ten or twenty times in my life and each time I wake up in a sweat and I don’t know what to do about it. ” I wonder about the content of the dream, but I hesitate to ask that directly. Maryann continues “In my dream I get pregnant. I know I am pregnant but I drink a lot of alcohol and then I wake up the next morning, in the dream, and I feel horribly, horribly guilty and confused. I can’t figure out why I drank knowing I was pregnant. I can’t stand to live with the guilt of carrying this baby to term and wondering what, if anything, I did to this innocent child’s brain. I tried so hard to get pregnant in the dream, that I am just amazed with myself that I could sabotage the experience by my drinking.” Maryann seems to be chastising herself as she describes the dream. It feels to me that the dream is a platform for her to express her self-hatred, but I don’t say that yet. “What do you think is going on?” I ask, wondering if we are going to come to the same conclusions. “”I don’t know,” she says. “I think that with my children grown, I feel empty inside, and yet at the same time, I don’t want to fill the space with another child.” I feel surprised by her interpretation of her dream. Like in my earlier post, https://shirahvollmermd.wordpress.com/2010/04/09/a-dream/, Maryann’s dream allows her to express her internal world in a way that would be more difficult if she could not frame it within the context of a dream. “In other words, your recurring dream expresses your ambivalence towards engaging with a new baby. Maybe a baby is not an actual baby, but a new project, a new focus for your life.” I say, expanding on Maryann’s understanding of her dream. “Well, it does not feel like ambivalence. It feels like I am a horribly stupid and foolish person to knowingly destroy a baby that I wanted so much.” Maryann says with utter contempt for herself. “It sounds like you are feeling guilty about something, and this guilt is very deep, hence your recurring dream,” I say, stating the obvious, but wanting to open up an exploration of her guilt. “I think I could have been a better parent. I think I could have been more patient with my kids. I feel really bad about that.” Maryann states, as tears roll down her face. “Tell me more,” I say, wanting to understand her better, and hoping that with self-understanding will come forgiveness. “I was working full-time. I had a very stressful job and when I came home I often yelled at my kids because I was frustrated with work,” she says with a feeling of terrible regret. “We have to stop,” I say, but I think we should keep talking about this. Your repeating dream mandates that.” I say, confirming that a recurring dream, even more than one powerful dream, is a good clue to a meaningful theme in Maryann’s internal world.

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Secret Love

Posted by Dr. Vollmer on December 13, 2010

    Karen, fifty-two, married to Rodney, also fifty-two, for thirty years considers herself happily married. Yet, when Henry, sixty-two, Rodney’s best friend comes over, Karen is both sexually and emotionally excited to see him. Henry is married to Deborah, although their marriage has been a bit rocky over the last three years, according to Karen. “I just feel like I am betraying Rodney since my feelings for Henry are so strong,” Karen tells me with an emotional tone which is both filled with guilt and pride. Karen seems almost boastful that she has this secret life with Henry in her head; at the same time, she feels bad for Rodney that her mind has strayed away from him. “Rodney does not deserve this. He has been so good to me for so many years, but I just can’t help myself,” Karen says with authenticity and pain. I find myself wanting to get concrete for a moment, just to be clear. “You feel loving and erotic feelings for Henry, but you and Henry have never discussed those feelings. You are feeling guilty because of your feelings, not because of any particular behavior.” Karen responds quickly “yes, that is right, nothing has happened yet.” “Maybe your feelings are a clue that you are missing something in your relationship with Rodney. Maybe if you understood the nature of those feelings, rather than being preoccupied with guilt, you could use the understanding of these mysterious to help your marriage,” I say, knowing that Karen knows that I would say that. “Of course that makes sense,” Karen responds. “I just don’t know how to get out of the guilt,” she says with angst and uncertainty. “What would happen if you allow yourself to have your feelings and then you allow yourself to be curious about why you are feeling that way?” I ask, trying to encourage curiosity without judgment. “Well, that is a hard one,” Karen responds. “The line seems so thin between thought and action,” she says with fear in her voice. “Yes, the line can be thin between thought and action, but with a good monitoring system, you can learn to trust yourself to thicken that line,” I say, trying to help her understand that her superego can remain intact, while she lets her id go off into the hinterlands. This process of trusting her superego, while exploring her id, might yield a deeper conception of her internal plight. “Thickening that line, that is interesting,” Karen says, as if she entered into a new room; a room for new exploration. “Your secret love, is even a secret to yourself,” I say. “Maybe it is time to let yourself in on it,” I say, trying to be a bit clever, but knowing this is no time for my humor. “Secrets are interesting that way,” she responds in a playful way. We end on a lighter note than we began.

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