Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for October 4th, 2012

Brain Birth

Posted by Dr. Vollmer on October 4, 2012

Freud’s 1913 paper on the technique of psychoanalysis describes the process as helping an individual give birth to a new brain. An intensive treatment, be it psychoanalysis or psychotherapy, helps a person think in a deeper way, thereby allowing them to make good decisions for themselves. In essence, the goal of treatment is to improve judgment and self-understanding. The goal, by contrast to other modalities of treatment, is not to change particular behaviors. The behavior change is the decision of the patient. The work is in changing how the external events in one’s world are processed with one’s internal world. For example, a colleague described a case where a patient many years later called him to thank him for helping him stop smoking. My colleague’s response was “I did not know you smoked.” It was the work of psychoanalysis that led the patient to better self-care, and hence he decided that smoking was deleterious to his well-being. The therapist did not have to tell him that. The therapist had to help him like himself better, such that he felt more invested in living in the world with the highest likelihood of longevity and good health. I say this now, in response to the new pressure on psychiatrists to have specific end-points or goals of therapy. These goals are usually thought of as symptom relief, such as eating and sleeping better. While symptom relief is critical to good functioning, it is also true that one has to invest in ones’ world, develop a brain which appreciates life, in order to maintain healthy functioning. Many people suffer from self-sabotage; they are their own worst enemy. As such, it makes sense, that the  logical intervention would be to stop the self-sabotage at it’s core, and not the outcome of that mode. Understanding self-sabotage, is the first step towards understanding so many kinds of human suffering. Focusing on the end-product of self-sabotage strikes me as a more limited intervention. We, as a field, need to listen to the details of the person’s narrative in order to see how they trip themselves up. By contrast, lumping all people with sleep problems, for example,  into one bucket, requiring one kind of intervention, simplifies the  human condition in a way that I find both disturbing and misguided. On the one hand, psychiatry appreciates the complexity of the human brain, as money is correctly being poured into neuroscience research. On the other hand, as a clinical field, the interventions proposed, both behavioral therapies and medications, as the antidote to human suffering, suggests a terribly superficial understanding of human behavior.  This is my rant.  I will  pause now.

Posted in Psychoanalysis, Teaching, Teaching Psychoanalysis | 3 Comments »

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