Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for July, 2012

The Withholding Husband

Posted by Dr. Vollmer on July 16, 2012

Abey, fifty, always felt inadequate in her family of four brothers. She is the youngest, and although she is an attorney, happy in her career, financially successful, she feels that compared to her investment banker brothers, she is the “poor relation.” Not surprisingly, she marries a man who never tells her she is pretty, smart or successful. Also, not surprisingly she feels she is “missing something” from her relationships. Abey suffers from underappreciating herself and thereby cultivating relationships in which ultimately she feels taken for granted. When Abey came to realize this dynamic, she was married for thirty years and taken aback by her tolerance for such little appreciation. This understanding led to some relief and some despair. “Do you know what it is like to be married to a man who has never told me I am pretty?” She asks, not wanting an answer, but wanting an appreciation for her deprivation. “I guess you recreated a relationship which was all too familiar for you,” I say, expressing compassion, understanding and sorrow. “Yes, but now what am I supposed to do?” She asks, this time expecting an answer. “Maybe you should begin by appreciating yourself?” I say, pointing to the fundamental problem that Abey has no sense of her own achievements and her own beauty. “I don’t know how to do that,” she says with tears. “I know. That is a big first step.” I say, helping her begin to tackle this larger issue of self-admiration, thereby changing the focus away from her husband and on to herself.

Posted in marriage, Psychoanalysis, Psychotherapy | 4 Comments »

Medical Issues As A Narcissitic Injury

Posted by Dr. Vollmer on July 13, 2012

Xavier, sixty-four, has a sister with Multiple Sclerosis, another sister with Scleroderma, but he has always considered himself the “healthy one”. “Out of the blue, I started having pains in my chest, and now I discovered I have cardiovascular disease. I had no idea. How can this happen? What did I do?” Xavier communicates with a deep sense of wonder and shock about his newly discovered medical issues. I am aware how abruptly he must change the way he thinks of himself, yet I am also aware that cardiovascular issues are common medical problems, so I am a bit taken by his sense of immunity to the medical issues of aging. “This diagnosis has really gotten to your core,” I say, highlighting that  the meaning of these medical problems for him, run deep. “I know they do,” Xavier says with good humor, acknowledging that there are narcissistic issues at play. His sense of being “better” than his sisters because he was healthy is a longstanding mantra for him, which his family supported. Now, that he has joined the ranks of those with chronic medical illnesses, he is no longer special. “I have to say that this diagnosis is really making me look at myself and how I see the world. I really did not know how important it was to me, psychologically speaking, to know that I was healthy. Now, I feel that my core sense of myself has been shattered, but of course, I know that makes no sense. I am still Xavier, and yet, now I feel like a different person.” Xavier says with an openness and curiosity that begins to explain his powerful shock over this news. “That makes sense, given that your identity was built on your health, so now that your health is in question, your identity is too.” I say, reviewing our understanding of his mental state. As Jon said in his comment to the previous post, it is a universal truth that people both want to fit in and feel special. Xavier felt special because he did not have medical problems, and hence this fragile basis for his uniqueness was likely to shatter as he aged. Fortunately, his curiosity about this shift in his mental state, allows us to explore the inner workings of his mind, allowing for a more solid reconfiguration of how he both fits in to his world and how he is special.

Posted in Narcissism, Psychoanalysis, Psychotherapy | 4 Comments »

Feeling Understood

Posted by Dr. Vollmer on July 12, 2012

Tea,,  was born with dislocated hips and club feet, discovered by her engineer father who after changing her older siblings’ diapers multiple times knew that Tea’s hip joints were not normal. The pediatrician missed the diagnosis, but no harm was done, as Tea’s dad saved the day. Tea’s parents took her to the local Orthopedic hospital, leading her to have casts on both feet and braces around her hips. When she started to walk, the braces on her leg made her walk like a Tin Soldier. Her knees could not bend. As Tea grew up, she knew that her body did not move right, although she looked normal. After multiple yoga classes, and discussing her skeleton with multiple teachers, one knowledgeable teacher guessed that because she walked at an early age without bending her knees, this caused the spine to have a different “rhythm” or curvature. Finally, Tea got some mental relief. Finally, someone could explain to her that her spinal limitations were not simply because she did not “stretch enough” as almost every other yoga and Pilates instructor told her. Tea tells me this story with tears and sorrow. “It is so hard to talk to people who supposedly know something about the skeleton, and yet, they respond to me in ways in which I know does not make sense.” “What is hard about that?” I ask, knowing that her issues are rare and that it makes sense that most yoga teachers are not educated in the developmental pathology of the spine. As if Tea were talking about a psychotherapist and not a yoga teacher, Tea looks at me and says “I am just tired of being misunderstood.” The transference here was apparent. Tea was misunderstood about her spine, but the bigger picture is her deep craving for understanding. Her search for a “good yoga teacher” was partly about yoga, and partly a search for a nurturing, understanding parent, who could latch on to both her inner and outer struggles. Her skeletal deformities were, in addition to being an obstacle to greater flexibility, are also a stand-in for how she feels psychologically deformed as well, and yet, no one can see that at first glance either. This image of a “hidden” deformity was powerful for her. Her skeleton looks normal until she bends over, at which point one can see a curve that is abnormal. Likewise, her personality seems normal until she engages in deep relationships, at which point her inability to express sensitivities becomes an obstacle to close connections. Once again, the inner and outer issues converge. Tea cannot change her spine; at least not without surgery. Yet, she can change how she thinks about her abnormalities. She can also appreciate those who struggle to understand her issues in contrast to those who dismiss her as “everyone is different”. This nuance of interaction is critical to her. Those yoga  teachers who respond to her report of her congenital issues by saying, “gee, that is really interesting, I am going to have to think about how to help you,” versus those who say “well, everyone has something they have to work on,” are dramatically different interactions for Tea.  Likewise, Tea is searching from me, from her friends and family, a curiosity about the uniqueness of Tea, and she rails against those who try to lump her into a bigger group. Tea is searching for that feeling of specialness, even if special means, more deformed. She wants to be understood. Who can blame her?

Posted in Psychoanalysis, Psychotherapy, Relationships, Transference | 5 Comments »

Zoloft Magic Or Poor Public Relations?

Posted by Dr. Vollmer on July 11, 2012



Nona, Carol’s mom, came to tell me that I “saved her daughter’s life. You just don’t know how hard it was for me to find you. I saw so many specialists and no one suggested Zoloft, yet it has made such a big difference, I just can’t tell you.”  Nona tells me with glorious praise. “I appreciate the gratitude, but I also feel terrible that you had such trouble finding the right kind of physician to help Carol. I wish there were a public relations campaign which helped the lay public understand that if their kid has extreme worries, then there is relief available.” I said, thinking that both the professional community and the lay public are unclear as to how children suffer from anxiety and how there is relief available. “Child Psychiatry should launch a campaign like the anti-smoking advertisements, which let people know that cigarettes were dangerous.” I say, articulating my fantasy to Nona. “Yes, but it is hard to prove the damages with an anxious kids. People die from cigarettes, but with kids there is no tangible problem with anxiety.” Nona explains to me in a way that makes tremendous sense. “Yes, it is not like kids end up in a wheelchair because they did not get Zoloft. The crippling of anxiety is much more subtle than that.” I say, knowing that in some ways mental illness is invisible in our society, yet in other ways, like when kids have no friends or they have multiple negative self-statements, mental illness is painfully visible. “Maybe you should just accept the gratitude,” Nona tells me, as if I am being self-deprecating. “I appreciate what you are saying, and I do feel good that I have helped Carol, but I also feel bad about your journey with Carol before you landed in my office. Both the educational institutions and the multiple medical professionals all sent you down blind alleys. I wish they had sent you to a child psychiatrist in the beginning of your journey since that would have saved you and Carol a great deal of grief.” I say, wondering why child psychiatry can be so obscure to so many people in the field of child welfare. I do want to see a public relations campaign which educates people about Child Psychiatry, in that we help children enjoy their lives so that they can grow and develop in the best possible way.

Posted in Anxiety, Child Psychiatry, Zoloft | 6 Comments »

Eating Anxiety

Posted by Dr. Vollmer on July 10, 2012

What do YOU eat for anxiety?

Posted in Anxiety, Cartoons, Eating | 8 Comments »

Losing Mentors

Posted by Dr. Vollmer on July 9, 2012

Tea,, just lost two of her most cherished mentors, a week apart. Leonard, age seventy-five, passed away after a five-year long deterioration, with no diagnosis. David, eighty-six, passed away after a brief episode of cardiac disease. Tea loved both of them. She believes they loved her too. “It is hard to describe my feelings,” Tea says, with some sadness, but also with a sense that she does not really know how she feels. “Their mentorship has carried me through some difficult times in my legal practice, and I will miss being able to talk to them, but I feel like I have internalized them so much that in some ways I won’t miss them.” Tea says, with a sense of guilt as though she should be having a harder time. “Maybe they mean more to you as an internal voice than they do as a physical presence.” I say, stating the obvious point that these mentors have helped give her confidence and so their day to day existence did not mean that much to her. “Yes, that makes sense, but I feel like there is something wrong for feeling this way.” Tea says with some awkwardness. “It is hard for you to give yourself permission to have your feelings without judging them.” I say, again stating the obvious point that feelings need to exist without judgment. “People in your life impact you in different ways, and it sounds that both Leonard and David have had their major impact on you through the confidence they gave you, and so it makes sense that you carry them around with you, so in that way you are not suffering a loss.” I say, reminding her that her minimal sadness does not mean that she did not care about her mentors. “Yes, I need to stop judging,” Tea says with dismay. “Both Leonard and David would have told me that too,” she says with acknowledgment to their importance in her life. “Maybe you can pay your feelings for them forward by mentoring others.” I say, suggesting that she might want to express her gratitude that way. “Maybe,” she says reluctantly. “Right now, I just want to absorb their loss.” Tea says, making a reference to the loss of her child. “That is a good idea. Loss is a big theme in your life, so I am sure we have a lot more to talk about.” I say, nodding to her struggle with losing loved ones. “Yea, that is for sure. Leonard and David both knew me when my son died, and  over the years, they were very helpful to me in so many ways, but at that time in my life they were not so compassionate. ” Tea, says, suggesting that she harbors some disappointment. “Yea, I can see how that still hurts you.” I say, thinking about how complicated relationships are, particularly long-term ones. “It is nice that you can see the layers of your relationship, and that there were supportive times, and some not-so supportive times.” I say, pointing out that she has maintained shades of grey. “Yea, that was hard on me early on, but I have gotten much better at that,” Tea, says as if to reassure me that our psychotherapy has been useful to her. “Between turning 50 and losing two of your mentors, you have been stimulated to think deeply about a lot of people in your life.” I say, bringing our sessions together. “Yea, I would like to be less stimulated,” Tea says, relaxing the mood, as she knows it is time to end.

Posted in Mentorship, Psychoanalysis, Psychotherapy | 4 Comments »

Lost Years Stimulated By Turning 50

Posted by Dr. Vollmer on July 6, 2012

Tea, turned 50 in December, but she is still fixated on this number. “I finally figured it out,” she tells me with great enthusiasm. “Yes,” I say, nodding that she has built up suspense. “Well, as you know, my son died twenty years ago and for me, the world just stopped. I was in a grief period, of course I still am, but I was really in another world for so many years, that turning 50 does not seem real to me. Everyone looks at me with a sense of recognition about how hard it is to turn 50, but I know that I am experiencing something that they do not connect to. I feel the loss of so many years where all I could think about was my son. That distortion, if you will, made me lose the normal tracking of time, such that I cannot latch on to my age. Sure, I have the other issues of aging, both body and brain, but that is not what is getting to me.” Tea relates this to me, as if she has solved a challenging puzzle. She is enthusiastic and not sad about her disclosure. “You know, it makes me sad to hear you talk about your son and particularly sad to hear how you feel you have so many lost years because of it. I am a bit perplexed as to why you don’t sound sad as you talk about it. At the same time, I can understand that you had an itch, which was the mystery of the meaning of turning 50, and now you have scratched it.” I say, knowing that we have discussed on numerous occasions how talking about her son is sad for both of us, but that does not mean we should not talk about him. “Yes, I do feel like I scratched an itch. That nails it. Before, I just felt so uneasy about my age, but it did not make sense to me, because normally I am not sensitive in that way. Now, it makes sense to me, so I feel better.” Tea, has done self-analysis, in a way in which she is communicating to me that the tools from our work together have helped her dig into her mind and test out hypotheses, until she lands on a concept that feels satisfying to her. “It must be so hard to ‘lose’ so many years, and have the people in your world not appreciate your feelings. I mean, I can connect with what you are saying, but it still must feel lonely.” I say, highlighting an old discussion about how Tea feels so alone in her grief. “Maybe you lost many years, but now that you have turned 50, you will be starting to appreciate time in a different way.” I say, highlighting that maybe this self-discovery will yield a deeper presence for her. “I can only  hope,” Tea says, now looking sad, but appreciative of our discussion.

Posted in Aging, Aging Brain, personal growth, Psychoanalysis, Psychotherapy, PTSD | 6 Comments »

Desperate As A Sad Self-State

Posted by Dr. Vollmer on July 5, 2012

Nathan, twenty-five, feels “desperate” for connection, as he relates his feelings to me. “I don’t find myself very likeable, so why would anyone want to hang with me?” He asks, conveying a low self-esteem, which has persisted since he was an elementary school student. “I have never really had friends.” Nathan says, as if proving his unworthiness. “Why do you think that is?” I ask, wondering how he strings together his own impression of himself and the outside world’s impression of him. “I think that people like me initially. I mean, I am really good at parties. I ask lots of questions and I am pleasant to talk to. Yet, as people get to know me, they lose interest.” Nathan says, as we explore his vantage point with regards to his interpersonal struggles. “Why do you think they lose interest?” I ask, trying to gather a larger narrative. “I think they lose interest because I feel so bad about myself, that at some deep level I push them away. I think they recognize how needy I am, and that scares people.” “Needy of what?” I ask, again trying to draw him out. “Needy of affirmations that I am a good person.” Nathan responds quickly. “You mean that if you had more self-confidence, then your friends would have more patience with you.” I say, emphasizing how importance self-confidence is to having deep relationships. “Yes, no one wants to be around people as needy as I am. If they don’t tell me how important I am, then I begin to get insecure and feel that they don’t like me any more.” Nathan says with brutal honesty. “It is great that you can articulate that process,” I say, impressed at his insightfulness. “Maybe we can figure out why your self-confidence is so low,” I say, pointing our therapy in the direction of self-esteem and away from his direction of loneliness. “I need sunglasses to leave right now.” Nathan says as a way for me to understand how sad he is feeling in this moment. “Yea, I get that and I am sorry about that.” I say, understanding that he is feeling very deeply as the session ends.

Posted in Loneliness, Psychoanalysis, Psychotherapy | 3 Comments »

The Job Miracle

Posted by Dr. Vollmer on July 3, 2012

Dibs, forty-one, got a job, after not having one for five years. Not only that, he is doing something he loves and making more money than he did in his previous job. Dibs, needless to say, is very happy. “How do you think things came together for you?” I ask, wondering if he thinks it is related to our psychotherapy, which has spanned ten years, and three previous employers. “Well, I have been trying to get a job. I really wanted one. I think some people out there get lazy, but I never did. I mean I did sometimes, but I always bounced back and I stayed focused.” “I see your point,” I reply, thinking that he never stopped thinking about getting a job, and even though at times, that made him very depressed, it also reminded him that he needed to try every avenue to see if there were opportunities. I can see that although our work together might have helped to keep him focused, it is also true that he was very hard on himself, which in a way, was painful to watch, but in another way, kept him in the game. “My mom died when I was fifteen,” he chimes into my thinking about how amazing it is that he landed a really good job. “And you wish she could see how happy you are right now?” I ask, knowing that I am finishing his sentence, but also fairly certain as to why he mentioned the saddest part of his life. “Yes,” he starts to cry. “I will never get over it. When she died, I was a mess. I did not get out of bed. I did not go to school. I did not talk to my friends. I know what it is like to shut down. I am just glad that I did not shut down when I was looking for a job. Otherwise, I don’t know what would have happened to me.” Dibs says, with gratefulness to himself for being active and resourceful. “You wanted to make your mom proud,” I say, pointing out that maybe he stayed active because he knew that his mom had faith in him and he wanted to prove her right. Dibs become overwhelmingly sad. “Of course, I do,” Dibs says with deep feeling. “Well, she is proud of you,” I say, also with deep feeling and appreciation for these moments that Dibs and I are sharing together. “Yea, I know. I am also really proud of myself.” Dibs says, ending our session, as we began, with tremendous hopefulness and exuberance.

Posted in Finances, Psychoanalysis, Psychotherapy, unemployment | 8 Comments »

Failure To Launch

Posted by Dr. Vollmer on July 2, 2012

Gina is at a loss about what to do with her twenty-three year old daughter, Karen, college drop-out. high school academic super-star, now doing odd jobs and living at home. “Let’s think about your options,” I say, trying to initiate a discussion about how to approach this issue. “You could kick her out of the house,” I say, being somewhat provocative in that I know this would be a challenge for Gina. Gina winces at the thought. “What are you afraid of?” I ask, knowing that she is worried about Karen’s survival, but also wondering how she will phrase her concern. “I am worried that her life will get worse if she has to think about supporting herself.” “What is wrong with her life getting worse?” I ask, continuing my provocation. “I just don’t think I could tolerate it.” Gina insists, as if her point of view is obvious to all. “I am not sure how you are tolerating the current situation,” I say, again, pointing out that Gina is going to be uncomfortable with every option. “Yea, but I am more uncomfortable with the idea of not giving Karen shelter.” Gina says, again, looking at me like there is only one way to think about her situation. “Motivation is a very important issue.” I say, suggesting that without a need, some people lapse into passivity. “I just feel so reluctant. Further, my husband would not go for it either. He seems to like Karen being home.” Suddenly, I feel my understanding has shifted. “I did not know that,” I say, pointing out my surprise. “Maybe their relationship is keeping Karen stuck in that she is afraid that if she changes her life then your husband would be upset.” “Yea, I have thought about that, but I am not sure.” I begin to think of the Oedipal triangle, and how much relationships can both propel development forward and/or keep people in a stagnant place. “I will talk to my husband, but if he is part of the problem, then I am really stuck.” Gina says, looking overwhelmed. “You don’t think your husband is open to looking at his side of the street?” I ask, assuming that he is motivated to help Karen. “I think he wants to think it is Karen’s problem, not his.” Gina says with deep pessimism. “See what happens,” I say, encouraging her to talk to him. “Meanwhile Karen will continue with her dead-end life,” Gina says with anger and concern. “Yea, but things can change, and maybe you can prod them along.” I say, recognizing the feeling of hopelessness that Gina feels.

Posted in Parenting, Psychoanalysis, Psychotherapy | 2 Comments »

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