Shirah Vollmer MD

The Musings of Dr. Vollmer

The Ugly Interior

Posted by Dr. Vollmer on October 18, 2012

Fear, aggression, envy, are all part of mental existence, yet, we as a society, seem to condemn these feelings to only belonging to those individuals who are deemed “not nice” human beings. This was the discussion in my “Psychoanalytic Technique” class where we tried to understand how we can help people embrace their minds without guilt or shame. “To understand negativity is to understand our patients, and this is one way to model relationships, where both good and bad is embraced and accepted. ” I say, trying to promote the concept that seeing the landscape is the goal, with a large push to eliminate judgment. Neutrality, as Freud advocated, meant understanding in a way which does not impose values.  This “neutrality” is one of the large challenges of our work, a skill which takes a lifetime to develop. “This is one of our tools,” I say to a student. “Yes, but I am not liking this tool box,” he responds. “Because the tools are never certain to work,” I respond. “Yes, I hate that,” he says, articulating the issue in our field that we try hard to help people, but we do not always feel like we are on the right track. “We need not just to be neutral, but to help our patients attend to their minds in a neutral way,” I say, again talking about giving people the freedom to examine their own minds. “The Dark Knight incident was a tragedy, but we should not be surprised that people have murderous rage,” I say. “Acceptance of this will be the first step towards helping people separate thought from action.” I say firmly, reminding my students that dangerous behaviors come from dangerous thoughts, particularly unexamined dangerous thoughts. “Talking about dangerous thoughts usually stops them from turning into behaviors, because the verbalization serves to release the tension, most of the time.” I say, wanting to carefully say that words often, but not always, discharge the tension which drives the behavior. “The mind may not be pretty, but it allows us to enjoy horror films for a reason,” I comment, trying to lighten the discussion as we all say goodnight.

6 Responses to “The Ugly Interior”

  1. Jon said

    “The Ugly Interior,” as you have called it, is indeed within us all. Yes, sometimes it is painful or repugnant to admit it, but, it is part of the human condition. Leaning to deal with this underside is necessary. As you have said, we can enjoy horror films for this reason. I would suggest that such experiences are cathartic. So, while you correctly state, “Talking about dangerous thoughts usually stops them from turning into behaviors, because the verbalization serves to release the tension, most of the time,” then I would add vicariously experiencing dangerous situations will also help with such a release. Catharsis is necessary to a healthy mental life.

    • Shirah said

      Yes. Jon, you bring up the issue, often bantered about, whether videogames, for example, help or hurt the adolescent’s violent tendencies. As always, both can happen, and so careful parental monitoring is the key to understanding whether media is a catharsis or a trigger. Thanks.

  2. Shelly said

    When are you, as a therapist, required by law to report these deep and disturbing thoughts to the authorities? If a patient were to express dark thoughts such as, “I have repeated thoughts about killing my father,” would you be required to report this or would you psychoanalyze the origin of the thoughts? I mean, how do you discern between something that is dangerous thought and the tendency toward action? In the US, there have been so many violent shootings and the psychiatrists have been crucified for not reporting their suspicions to the authorities (and even if they have, they still have been crucified!). When do you act, and when do you not?

    • Shirah said

      As usual, Shelly, you bring up the tough questions. As a psychiatrist, I am a mandated reporter for any suspicion of child abuse or elder abuse. I am also mandated to report if I understand that a specific person’s life is in imminent danger. Of course, all of this leads to gray issues, where I seek consultation and try to make the best decision possible. Thanks.

  3. ashanam said

    I find it impossible to be neutral, but I can see myself with compassion. Maybe that’s easier.

    • Shirah said

      Hi Ashanam,
      You bring up an interesting issue about the overlap of neutrality and compassion. Many people see psychoanalysts as “cold” because they are listening intensely, whereas others experience this kind of listening as compassionate. Compassion is a hard concept, since it is more than empathy in that one is thinking and feeling at the same time, while listening to emotional trouble. To be compassionate is to be without judgment, but I think your comment implies correctly, that no one is ever without judgment, but one tries to keep a lid on this so that one can appreciate what the other one is saying. Judgment gets in the way of good listening. Thanks for chiming in.

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