Shirah Vollmer MD

The Musings of Dr. Vollmer

The Car Accident

Posted by Dr. Vollmer on March 29, 2012

Louise and her dad come in for their weekly visit with looks on their faces which speaks to a traumatic event. Louise, age six, says “we have been through a lot,” in a way that conveys she does not want to tell me all of her news in one sentence. Although only six, she seems to want me to guess as to what might have happened to her. She is teasing me, in a playful way. Larry, her fifty-year old dad, chimes in, “we had a car accident.” Larry’s tone and body movements are different than usual; he is more tense and uptight. Louise jumps in, “we got to ride in a big truck,” she says with excitement for the novelty of riding in a tow truck. Larry, who is not the focus of the treatment, concerns me in his demeanor. He has the appearance of “shell shock,” I tell him. It is the look of stiffness and detachment. Louise, on the other hand, appears relaxed and happy. Louise has some behavioral problems at school, but through our work together, as Larry tells me, she has calmed down quite a bit. “I have to say I am concerned about you, Larry,” I say, trying to walk the fine line of expressing a clinical judgment to someone who has not consented to be my patient. “Yea, it was pretty scary. I had Louise in the car and I just can’t believe how close we were,” stopping his sentence right before he seemed about to say how close they were to dying. “I can certainly imagine how terrifying that is,” I say, understanding that the motor vehicle accident broke through Larry’s denial about the finite quality to our lives. I know the accident was recent and that with time, Larry is likely to restore his old defense mechanisms, but I want to tell him that if this “shell shock” quality does not go away, then he should seek professional consultation. I am not exactly sure how to say this, so I end up saying, “let’s meet next week without Louise and see where we are.” Traumas are openings for the re-working of internal structure, but first they create a numbness that speaks to future suffering when the numbness wears off. “I am glad Louise is doing better,” I say refocusing our work back to Louise, but still concerned about Larry. “Yea,” Larry says with a flatness that is uncharacteristic for him. We stop on that heavy note of flatness.

4 Responses to “The Car Accident”

  1. Shelly said

    Interesting. I was under the impression that when a child has “behavioral problems at school,” that the parents need to have “parental guidance” with a professional as well. That would mean that in a tangential way, Larry is indeed your patient, although not directly. How do you read Larry’s reaction to his close brush with death? Does it not sound normal to his experience? With Louise in the car, shouldn’t she also have had some reaction as well? Her appearance of being relaxed and happy after having been in a near-fatal car accident seems somewhat off-kilter, doesn’t it? Even a child of 6 would know that being in a car-accident was not a normal event and was scary. Her father’s fear (as expressed in tone and body movements) could possibly be read by an observant child, could it not, which could have then have been transmitted to Louise? What does a “tone of flatness” signify, anxiety or worry?

  2. Yes, behavior problems at school are often a good prompt to help the parents with issues of discipline and boundary setting. Larry is my patient in terms of helping him be a better parent to Louise, but he has not consented to being my patient for his own well-being. One could argue that the better Larry’s well-being, the better parent he can be to Louise, but still he has to agree with that premise before I can safely offer up my professional judgments.
    I read Larry’s reaction to his brush with death as a time in his life where he has been prompted to think long and hard about his priorities.
    Louise may or may not have had a reaction to the car accident. That is very dependent on Louise’s make-up and her state of mind before the accident. She could read her father’s fears, but this could also not concern her.
    The “tone of flatness” signifies that he is in shock, and like novocaine, when the shock wears off, there is pain underneath. Thanks, as always.

  3. Jon said

    Car accidents can induce a real form of shell shock, or more modernly, post traumatic stress disorder. The old standard approach to falling off a horse was to get back on the horse again. That seems to translate into getting back to driving again for Larry. (Parenthetically, it is understandable that Louise did not have a bad experience given her age and that she was not literally in the driver’s seat.) Understanding that each case is different, what is a general approach to dealing with Larry’s situation? What are the things to look for in the specific cases such as Larry’s?

    • The major issue for Larry is how he is going to deal with this accident over time. Initially, as you suggest, most people are going to be shaken up. However, as time ticks away, the anxiety around the traumatic event usually fades. For a few people, the anxiety does not fade and for them, intervention, be it medication and/or psychotherapy, can be very useful. Thanks.

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