Shirah Vollmer MD

The Musings of Dr. Vollmer

The Amnestic Response

Posted by Dr. Vollmer on February 12, 2012

  Nisha, fifty-seven, is trying to figure out her life now that her kids have left the nest. She wants to believe that she has a good relationship with her husband, but when he does not consider her when he makes major decisions she feels depressed and despondent. Other times, when they are with their friends, she gives off an image to others and to herself, that she and her husband are a “good team.” Some days,  Nisha is getting divorced and making plans to “get on with her life.” Other days, Nisha is planning romantic trips for her and her husband to go on so that they can celebrate their life together. When I see Nisha and I remind her of her flip-flop, she acts as if she has no memory for the other state. That is, when she is “ready” to divorce her husband, then she wants to talk to me about that. When she is “happy” with her husband, then there is nothing to talk about in that department. When I remind her that it was just “yesterday” that she was thinking about leaving her marriage, she looks at me with a glazed look. She knows that to be true, but she does not want to be confronted with her rapid change of mind. Her defense is such that she shuts one door and opens another, without looking back as to where she came from, or from what happened yesterday. This results in a lack of continuity in her own mind and in the mind of those she confides in. As she is having trouble integrating her conflicting feelings towards her husband, she has compromised with this conflict by adopting what I call “a flip-flop or amnestic approach” to challenging situations.  As her therapist, it is my  job to create internal continuity, to develop a thread which runs through her mental existence. I need to help her be less amnestic and more narrative about the range of her feelings. Remembering and working through, Freud called this process. Two ideas, so easy to state concisely, so hard to operationalize.

4 Responses to “The Amnestic Response”

  1. Jon said

    There is no question that your task is to help Nisha end her amnestic approach. The question is how to develop the internal continuity to achieve that end. How does one do that?

    • The answer, Jon, is “working through” meaning the work of co-constructing a narrative which is more cohesive then her current narrative which is fragmented. This process is about slowly diminishing what she wants to believe in exchange for what she knows to be true, however painful that might be. This is a difficult, and at times, a tedious process, since there is a push/pull in her, or anyone’s desire, to wrestle with certain painful truths. The idea of “hate me now, love me later,” (perhaps a title of an upcoming blog) is that the path to this cohesive narrative can be painful, but like chemotherapy, ultimately life-saving-maybe. Thanks.

  2. Shelly said

    It’s not really “amnesia,” it’s ambivalence about how to move forward into the unknown. Sometimes it’s easier to stay with the hard present than to move forward into what could be the worse future. How many of us have put up with bad bosses or jobs, annoying neighbors, or other challenges because we’re afraid of the first step? And if your patient suddenly goes back on her decision to divorce her husband, then perhaps she was ambivalent about the decision in the first place. Perhaps there were some considerations that she didn’t voice to you?

    • Amnesia and ambivalence are on a continuum. Ambivalence would imply that she is aware of her mixed feelings. Amnesia, which may represent ambivalence, implies that she is unaware of her feelings from the previous day, week, month, etc. Yes, change is difficult and scary. The older one gets, the more difficult and the more scary. I am sure there are considerations which I am not aware of, but the purpose of this post was to highlight the brain’s ability to contradict itself, in a way in which the observer can easily see the confusion, but the individual does not.

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