Shirah Vollmer MD

The Musings of Dr. Vollmer

Fragmented Thought: The Case For Psychoanalysis

Posted by Dr. Vollmer on April 10, 2012

Nona, twenty-one, seems unable to finish a thought. Every sentence sounds like a fragment. “I just hate the way my father treats me,” she says. “What about how your father treats you?” I ask. “I just hate the way he treats me,” she repeats. The inability to flesh out an idea seems to be a symptom, a resistance as my psychoanalytic colleagues might say, of a larger issue that she is afraid to get to know herself. She seems afraid to try to discover how she is thinking or feeling. The fragment, again to use psychoanalytic language, is a defense against understanding the depth of her mind. As we work together intensely, the hope is that we will be able to push through this fear such that she can become more familiar with her internal world. This is clearly foreign and frightening territory for her, as shown by her inability to complete an idea. The window into her brain is opened by her repetition, by her reluctance to take an idea further. In other words, the fragmentation is a clue to how painful things will be as we proceed. The defense, if you will, is protecting her from understanding her difficult and tortuous feelings, both currently and from her past. It is only with intensive work that we can push through her fragmentation. The frequency of our sessions allows us to more closely examine this pattern of incomplete thoughts. This close examination is essential to helping her see  her thinking as a difficult way of protecting her from herself. In other words, as she understands why she needs to think in fragments, she will be able to think in more complicated ways, thereby allowing her to make more sophisticated decisions for herself, as her life unfolds before her.   Our work has begun.

8 Responses to “Fragmented Thought: The Case For Psychoanalysis”

  1. Jon said

    Yes, Shirah, you and Nona have a long road to travel. Nonetheless, upon first reading your quote of Nona’s fragment, “I just hate the way my father treats me,” I could misinterpret her comment. Her father could be a doctor, and she could be unhappy with his treatment of some condition. However, this could still be the case in a more general situation. Nona does indeed hate the way her father treats her as a person, most probably. Thus, your question, “What about how your father treats you?” is the proper next step down that road – from fragments to sentences to understandings.

    • Thanks, Jon. Yes, the ambiguity of the comment “I hate the way my father treats me” is my point. That coud mean all sorts of things and that without further explanation there is no clarity of thought. Without clarity of thought there can be no clarity in decision making and hence life must feel chaotic to Nona. This internal chaos is often expressed by externalizing life events, as if one is the victim of one’s circumstance, rather than the cause. Understanding this distinction is often the psychoanalytic work. Thanks, as always, for helping me flesh out my ideas.

  2. Carol said

    Nona is lucky to be working on this at age 21!

  3. Hi Carol,
    Welcome to my blog. Thank you for your comments. I agree, although I also think that at any age, this kind of work is a worthwhile endeavor. The choice of living with fragmented thoughts versus living with a cohesive narrative seems straight-forward to me, although the journey is arduous. Thanks Again.

  4. Shelly said

    Interesting blog. Are you saying that someone who speaks in fragments so as to make their speech incomprehensible speaks this way because of resistance? Because of some internal fear or turmoil, like an internalized stammer if you will? How is this treated if the person does not have routine psychotherapy but rather occasional treatment? What can be running through this person’s mind that causes the fragmented speech?

    • Hi Shelly,
      Thanks. Yes, I am saying that sometimes, I would even say often, the fragmented thought pattern is a resistance or a defense against understanding one’s inner workings. I really like the idea of an internalized stammer. That is a wonderful way to put it! Thank you for that. This is not amenable to intervention through occasional treatment, as one needs intensive focus to sort this very subtle, although disabling condition. An example of a reason for fragmented speech is the lack of a sense of self, such that the fragmented speech serves as a way to deflect from the issue that there is no identity formation. Identity formation is key to forming cohesive thoughts. One must have a sense of who they are in order to think clearly. Thanks Again!

  5. kim bjorkland said

    Have you tried to ask your patient to write – or more appropriately, TEXT or tap out on a blackberry her feelings?

    Is it possible that an entire generation doesn’t know how to communicate verbally?…

    Best regards

    • Hi Kim,
      Thanks for your comments. You raise an interesting point, but in this case, I don’t think that Nona’s issues stem from tools of communication, but rather from deep internal struggles. Still, I take your idea that the emphasis on texting, as opposed to talking, will change brain development. Thanks Again.

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