Shirah Vollmer MD

The Musings of Dr. Vollmer

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.

3 Responses to “Brain Birth”

  1. Shelly said

    I applaud you, Shirah, for standing up for understanding the human condition. Unfortunately, psychiatry as a whole is suffering because HMOs only fund the 10-minute session for med-checks. They don’t care about understanding: they want patients to be medicated and out the door. Think about it: if you can see 6 patients per hour and prescribe medications versus 1 patient per hour for talk therapy, where do they stand to lose more money? As I see it, fewer med students are going into psychiatry because they can “cure” fewer people. Do you really “cure” patients, or do you simply help your patients alleviate symptoms? In any event, I would always choose to go to a therapist like yourself, one who strives to understand the human condition.

    • Jon said

      I second Shelly’s applause, but I think the problem is even more universal. Health care, in general, is being forced to be more “efficient.” As such, the problems of mental health care are indicative of what may be a pyrrhic victory of “streamlining” modern approaches to the problems of mind and body. Hopefully, a more reasonable system will prevail.

    • Thanks, Jon and Shelly. I do applaud efficiency, but not at the expense of denying complexity. I know that you both understand that, but I wanted to say it again. Thanks again.

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