Shirah Vollmer MD

The Musings of Dr. Vollmer

The Mute Patient

Posted by Dr. Vollmer on August 7, 2012

Louise, forty-one, high-school librarian for the last twenty years, sees me once a week, but she hardly says anything, at least that was true up until her fifth year in treatment. She would come, stare at me for a while. We would sit in silence, surprisingly with a sense of comfort with one another. I would ask her some open-ended questions, she would answer with a word. “How are you?” I would say, with enthusiasm that comes with looking forward to seeing her. “Fine,” she would answer, rather abruptly. Then, we would return to silence, broken by me speaking again by saying “it seems like you don’t feel like talking today,” to which she would nod in the affirmative. We would sit in silence again, until I started musing with her. “I am wondering about your work, your play time, your relationships,” all of which I knew little about. She would look at me, with no verbal response, but with an expression that made me think she was pleased that I was thinking about her. Eventually the sessions would end and I would say, “see you next week” and then she would politely get up and leave. I suspected that, as with many mute patients, both children and adults, that Louise had a lot to say, once she was comfortable saying it. Sure enough, one day, seemingly out of the blue, Louise started talking. She described a traumatic past of not knowing her father since he left when she was an infant. Her mother was “mean to the animals” she said, as a way of saying, if you can be mean to pets, imagine how mean you can be to your children. Over time, Louise went on to describe both physical and emotional abuse at the hands of her mother, although her younger sister was not victimized in the same way. For reasons which Louise is confused by, Louise was the target and focus of her mother’s rage. “So why do you think you were so quiet with me for all of these years?” I ask my long anticipated question. “I wanted to see if I could trust you. I could not trust my mom, so I had to check you out to make sure you were not like her,” she responds, as if she knew that question was on my mind. “So how did I pass the test?” I asked, having no idea of the answer. “Well, you were patient with my silence for such a long time, I figured that had to be a good sign,” Louise responded, surprising me that it was simply my tolerance and acceptance for where she was at, that made her feel that she could trust me with intimate details of her early life. In that moment, I felt such gratitude to so many of my teachers from medical school, psychiatric residency, child psychiatry fellowship and analytic training, who taught me that patients get comfortable in their time and not ours. So true.


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4 Responses to “The Mute Patient”

  1. Jon said

    Your experience with Louise is an incarnation of the more general problem of building trust between people. Positive shared experiences – as complicated as surviving a catastrophe to as simple (as with Louise) as comfortable mutual silence – seem to be necessary. As you have pointed out, the timing of building such trust is on each person’s schedule, especially if there has been trauma with trust in the past. Congratulations for passing such a major milestone with her.

    • Thanks, Jon. The purpose of this post, as I am sure you inferred, is to remind folks that in our current day push to prescribe quickly, there is a lack of an appreciation for how important time is, in uncovering issues which are at the core of major symptoms. Without this kind of patience, so much of the richness of personality is missed. I was taught that over and over again and for that, I am grateful. At the same time, I fear for my younger colleagues who seem to not be exposed to this notion. Thanks Again.

  2. Shelly said

    If you were one of your young colleagues who had seen Louise once or twice, what would your take of her behavior and her problems have been? Would you have quickly come to a different diagnose and treatment plan? Would you have become impatient with her and have tried to ‘divorce’ her from your practice for being uncommunicative?

    • My suspicion is that without a lot of time spent with Louise, she would have been mistaken for someone who is psychotic since, at times, her limited interaction with me, could have been confused with paranoia. In fact, she was worried about me, but not in a psychotic way. People who suffered severe trauma can be confused with paranoid schizophrenics, although in Louise’s case, it was clear that she was functioning well at work. Thanks. .

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