Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for April, 2011

Sibling Rivalry: Revisited

Posted by Dr. Vollmer on April 5, 2011

elderly care

Tamara, comes in saying “I don’t want to talk about my mom today. I want to talk about my older sister Thais. Thais was two years ahead of me in school and she was an absolute genius, according to my mom. So, when I came along, my teachers expected me to do as well as she did in school so when I did not catch on to things as quickly as Thais did, my teachers seemed really disappointed in me. My whole life I have tried to define myself as just as good as Thais, but deep down, I have never felt that I am.” “I am curious why this is coming up now,” I ask, trying to tie together Tamara’s struggle with her ailing mom and her presentation today about her life-long feelings of inadequacies which she attributes to being the younger sister of Thais. “Well, I guess I see my mom’s passing and I am thinking a lot about my childhood and I am thinking about how even though I am fifty years old, I still carry around a lot of very old feelings which don’t seem to go away.” Tamara explains with a sense of agony and frustration. “These feelings are hurtful and persistent,” I say, “and it sounds like you wish these feelings would go away but they seem to stick around like they are cemented into your core.” “Yes, that is exactly right. They are cemented to my core and I hate that,” Tamara says with a tone that conveys both  the recognition of feeling understood and the pain of a life-long feeling of inadequacy. “Maybe these feelings were cemented in because it was not just the teachers that you felt to be disappointed, but also your parents as well,” I say, thinking that her parents might also have compared Thais to Tamara and in so doing, her parents could have been disappointed by Tamara’s intelligence relative to Thais’ cognitive abilities. “It is impossible for me to think that I disappointed my parents, especially now that my mom is dying,” Tamara says with overwhelming sadness and teariness. “You mean the last chapter in your mom’s life reminds you that you are losing the chance to ever impress her with your accomplishments,” I say, trying to convey a sense of understanding how hard it is to lose that opportunity. “Yes, I am going to have to accept that my mom saw me how she saw me, even if that makes me feel that she was chronically disappointed in me,” Tamara says with strength in understanding and deep pain at the same time. “Needless to say, your mom’s failing health has become a focal point for you to focus on how the past inserts itself into the present,” I say, trying to summarize how Tamara is filled with a stew of complicated and painful feelings, set off by her mom’s failing health. “Maybe there is opportunity here to begin to see yourself independent of how your family saw you,” I say, trying to introduce the notion that she does not have to see herself the way she feels her family sees her. “That would be nice,” Tamara says, “very very nice.”

Posted in Aging, Siblings | 2 Comments »

The Ailing Mom

Posted by Dr. Vollmer on April 4, 2011

elderly care

 Tamara, fifty, is watching her mother’s slow and long decline as her mom travels in her last chapter of her life. Tamara’s mom, Thelma is eighty-eight years old and her health has been slowly declining for thirty years. She has type II diabetes, heart disease and rheumatoid arthritis. Her mind is good and active, but Thelma’s body betrays her more and more every decade. Her diabetes, although well controlled, seems to have caused her significant mobility problems along with problems transferring from a bed to a chair. Without limited ability to transition, Thelma is almost, although not completely bed-bound. Tamara is helpless and sad. I offer Tamara support, but the realities of Tamara’s struggle watching Thelma slowly lose functioning is heart-breaking and lonely. Sure, Tamara has siblings, three of them, but for reasons which are not clear to Tamara, they do not seem to feel sad or helpless about Thelma’s situation. They seem to take it in stride, or at least that is how Tamara perceives it. Tamara has a husband; she has been married for twenty-eight years. “He tries, but I don’t think he understands how I am feeling either,” Tamara explains to me. “And your children?” I ask, knowing that Tamara has three children between the ages of eighteen and twenty-two. “They try, just like my husband, but it still feels really lonely,” Tamara persists in telling me how alone she is feeling dealing with Thelma. “What would make you feel less alone?” I ask. “If I had someone I could talk to every day about what it was like for me to visit Thelma. I mean I can talk to my husband every day but he changes the subject and that drives me nuts,” Tamara explains.  “Is there a way you can soothe yourself?” I ask, wondering if she is taking care of herself through the stress of Thelma’s decline. “Well, I am here,” she says, almost humiliating me with my question. “So, does coming here feel nurturing?” I ask, so as not to assume I know the answer, since I don’t. “Yes and no,” Tamara says. “I think you understand, but it is not like I can call and chat with you after I see my mom and sometimes I feel like I really need that,” Tamara explains. “Maybe you can tell your husband that you need him to listen better,” I say, trying to have Tamara’s support system work better for her. “That’s a lot of work to teach him to listen, but I guess I have no choice,” Tamara says with dismay. “I am sorry about your mom,” I say, implying that we have to stop soon. “Yea, thanks,” Tamara says, with a tone of appreciation and a tone of sarcasm at the same time. I wonder to myself how much Tamara has trouble taking in the support of others who really care about her. I think I will weave that into our next session, if that still makes sense. The epidemic of middle-aged folks dealing with ailing parents hits me once again. I wonder about community support systems that can help people like Tamara. I will look into that. A multi-pronged approach makes sense, yet again. It is time to bring out the big tool box.

Posted in Aging | 3 Comments »

The Wicked One

Posted by Dr. Vollmer on April 1, 2011

  Brew and Paul are fifty-year old fraternal twins, both physicians; they  have no other siblings and their parents have always been married to each other. They live on opposite ends of the country.  Their mom died of cancer two years ago. Their dad, Stewart,  is still living, at age eighty-seven, but he has multiple medical problems. Recently, Stewart had a severe hypertensive episode, requiring immediate hospitalization. Brew, the brother that lives in the same city as Stewart, attended to him and reported his impressions to his brother Paul. Paul, as he usually does, demeaned Brew, and told him that his ideas and thoughts were “simply wrong.” Paul continued to say that Brew was not being a good son, because a good son would go out and buy Stewart new books so he would have something to do in the hospital. Brew hangs up the phone with Paul, partly devastated and partly feeling that familiar family dynamic where Paul is the “know-it-all” and Brew is a slow-thinking, barely capable person who only succeeds because he works so hard, not because he has a good intellectual functioning. Brew feels that Paul is the “wicked one,” because Brew has felt put down by Paul his entire life.  Brew knows that Paul is thinking about Stewart from a distance and that is very different from eyeballing Stewart. “It takes gall for Paul to comment on my dad’s condition, without laying eyes on him,” Brew tells me, and I agree.  

     Despite the fact that they are fraternal twins, their mother always treated Paul like he was the older and wiser child. Brew was treated like he was not very “smart” or at least no where near as smart as Paul; at the same time Brew was told that if he worked hard enough he could compensate for not being so smart and thereby still accomplish in the same way that Paul would. Brew took this message as a challenge, such that Brew worked very hard to go to medical school, since he knew that Paul was headed in that direction. As his mother told him, Brew believed it was his hard work, not his sharp mind, that got him to progress professionally. Paul believed this too. Over the years, Paul has frequently attacked Brew with the notion that he was not “smart” so his ideas are not as good as Paul’s. In so doing, Paul seemed to feel that he won the favoritism of his mother and his father. Further, Paul seemed to be in constant fear of losing his perch, such that he seemed to keep reminding Brew, and his parents that he was the “better” child. The most egregious example of this came about twenty years ago when Brew’s young wife died quickly from a malignant brain tumor. Brew was heart-broken and he felt the need for his family. Paul attended to their mom, as she was understandably distraught, but Paul never paid much attention to Brew around this tragic event. After that, Brew felt he got clarity about his relationship with Paul; there was no relationship. In his time of need, Paul evaporated. Brew felt that to be unforgiveable. Brew also understood that Paul’s behavior stayed remarkably consistent. Paul maintained the life-long battle of fighting to have the most attention from his mom and his dad. When Paul attended to his mom when Brew’s wife died, he also prevented their mom from attending to Brew. The tragedy became the mother’s tragedy, not Brew’s tragedy; at least that is how it felt to Brew.

   Now that Brew and Paul have to tend to their ailing father, Brew understands, but is still hurt, that Paul’s behavior seems to once again be an attempt to show that their father loves him more. “It is sad” Brew tells me. “One day our father will pass on, and there will be this deep hurt between us.” “Yes, that is very sad,” I say, reinforcing that sometimes, not very often, sibling rivalry is so severe that the competition for attention never stops, thereby prohibiting a closeness in the siblings. In that sense, the outlook looks grim. On the other hand, Brew’s recognition of the problem helps him take Paul’s behavior less personally, and allows Brew to see himself in a way that is very different from how Paul sees him. That process has been exciting and painful at the same time. Brew may call Paul the “wicked one” but unlike in the past, Brew does not have  to feel bad about himself. As Brew was growing up, it did mean that. Time, maturity and psychotherapy have changed things. Brew is grateful. I am privileged to play a role.

Posted in Siblings | 2 Comments »

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