Shirah Vollmer MD

The Musings of Dr. Vollmer

The First Smile: 14 Years Into Treatment

Posted by Dr. Vollmer on November 15, 2011

   Lilith, sixty-three, has seen me for fourteen years, since she was 49. At that time, she was convinced that every police car was after her to arrest her for a crime, she was not sure she committed, but she was certain she would be arrested. At a younger age, Lilith dropped out of medical school because the voices were intolerable. She never used drugs or alcohol, she says. She had a history of multiple psychiatric hospitalizations in her twenties. In the fourteen years that I have seen her, she has held a job, isolated from most people, and paranoid, particularly about the police. Her medications have not changed. She remains on typical psychotic medication, at low dose. She is compliant with her regimen, as she says, “it makes me less concerned about the police.”

    Normally our sessions are heavy. Lilith looks to me to reassure her that the police do not want to arrest her. She says she knows, but she likes when I say it too. Astonishingly, on a recent visit to see me, which is almost always when she is feeling particularly anxious, I saw Lilith smile. “I have never seen you smile before,” I say to her, recognizing that we have never had a relaxed feeling together. “My life is so much calmer now. Maybe it is because I am getting older. Maybe I just don’t think about the police as much, but I just feel more comfortable,” Lilith explains in a way that we have never talked before. “Did anything change with your medication?” I ask, wondering if she increased her medication without telling me, even though she has never done this before. “No, I just feel that getting older has made me more relaxed,” she says, with  insight into her condition, which she demonstrates intermittently. “It is certainly nice to see you smile,” I repeat as a result of my surprised feeling. “Yea, life is better,” she says with a lightness, so uncharacteristic of our previous visits. I wish I could say I could see this coming, or that I understood why her paranoia subsided, but I can’t. I am just happy it did.

2 Responses to “The First Smile: 14 Years Into Treatment”

  1. Shelly said

    What crime does she think she committed that she would be arrested for? Is this type of paranoia typical of schizophrenics? Does schizophrenia wane with age? How can you, as her psychiatrist help Lilith manage her symptoms, other than with medication? Does talk therapy help?

    • She does not think she committed a crime, but she does think the police are after her. It does not make sense. Yes, this is fairly typical for paranoid schizophrenia. Yes, our relationship has been helpful to her in managing her symptoms. She would tell you that. Talk therapy, in the traditional sense, does not help, but our connection helps calm her down. in other words, we do not explore in-depth the workings of her mind, but in our time together, we establish a trusting relationship. Thanks.

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