Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for May 20th, 2013

A Psychoanalytic Rant

Posted by Dr. Vollmer on May 20, 2013

1993-2001 were the years that I did psychoanalytic training at an institution then called Los Angeles Psychoanalytic Institute (LAPSI), and now called the New Center for Psychoanalysis (NCP). This training involved 200 hours of supervision to discuss 800 hours of patient care activities. Plus, I had four hours of seminars a week for four years, that came along with four hours of reading each week, to prepare. At the end, I had to pass an oral examination, write-up four cases, and go before a committee to qualify for graduation. This work, done in the midst of  my development of a psychiatric practice, was a questionable activity, according to those who followed me through my path. “Would it earn me more money?” Some folks would ask. “Nope” I replied proudly. This education was not intended to pad my income. Clearly it was a financial sacrifice, given the many hours of dedicated time to understanding psychoanalytic thought. Given the paradox of this educational activity, I was rather closed-mouth about it. Psychoanalysis, at the time, was thought to be “going out of business”. I understood that, but I maintained the conviction that deep understanding of the human mind is valuable to any kind of interpersonal activity, be if professional or personal. Over a decade after graduating, I am immensely proud of this accomplishment, and deeply connected to my work. I now teach at psychoanalytic institutes with the notion that the torch carries on, despite insurance pressures to the contrary.

My current rant centers around the notion that this eight year journey of mine is not always clear to those in educational institutions. More specifically, when volunteer teachers are sought, there is no targeted search for those with psychoanalytic training. This catches me by surprise, because although one could argue that the business of psychoanalysis might be fading, the need to teach in-depth psychotherapy skills is still a valuable entity. As such, the more depth one has as a clinician, the better the teaching could be. As a psychiatry resident in the 1980s, I made sure that all of my teachers/mentors were psychoanalytically trained, because this background enhanced their ability to articulate the ideas of the human mind. Without this training, I experienced teachers who, although bright, were often at a loss as to how to explain human motivation. One needs to cite  the literature, a skill developed over years of instruction, not given in psychiatry residencies that do not have a psychoanalytic bent.

The internet, however, gives me some hope.   This post, along with others, allows people from all over the world to chime in about their psychoanalytic journey, thereby reassuring all of us, that psychoanalysis is alive, making the need to teach deep thinking, alive as well. Perhaps this teaching will not go on at universities, but rather in free-standing institutions of psychoanalytic thought. This thought, likely to be true, gives me pause. Without the backing of a university, psychoanalytic thought will lose its intellectual rigor. A university needs to ponder the many ways of thinking about human behavior. Likewise, psychoanalysis needs the university to fertilize the thoughts that are in parallel with our explosion in understanding the mapping of the human brain. This divorce of in-depth psychology from universities is the basis of this rant. Some might say that the humanities keeps psychoanalytic thought alive, as many people who study literature and anthropology are concerned with human motivation. Although that may be true, it is still sad to me that psychoanalytic thought is being divorced from neuroscience. These two disciplines can learn from one another.

Posted in Psychoanalysis | 11 Comments »

My New Yorker Entry

Posted by Dr. Vollmer on May 20, 2013

 

“I said we need to know your weight, not to levitate.”

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Moral Injury

Posted by Dr. Vollmer on May 20, 2013

 

Moral injury, a concept implying that one’s behavior goes against one’s morals, both individually and collectively. Behavior in one setting. like murder, is considered evil, but in the context of war, taking a life, is understood in a different way, and yet, it brings up the possibility of profound guilt, which, in my mind, is almost identical to moral injury. The idea that one can feel good about a behavior in the moment, but upon reflection, can have crippling regret, is the power of the human psyche to re-evaluate one’s actions with superego ideals, leading to despair, with the challenge of subsequent forgiveness. Suicides are high in our post Iraq and Afghanistan veterans, and so it is possible, but not proven, that this high rate of self-destruction, is due, at least in part, to a particular crisis in moral injury. Perhaps the behaviors of our returning soldiers, in retrospect, is too painful for words, too outside the concept of forgiveness. So, the question is whether the term “moral injury” furthers our understanding of these veterans, or whether it is redundant, given our established diagnosis of PTSD. I think “moral injury” focuses on guilt, whereas PTSD focuses on hyperarousal. Both are key components to the disabling psychological trauma which many of these veterans experience. “Moral injury” adds on to the multifaceted way in which those who have gone through an experience, so outside of mundane human activity, are left with a mind filled with confusion and anxiety. Understanding this suffering, perhaps by crystallizing a part of it under the term “moral injury” is one step further to helping those who suffer alone, join a community of empathic souls.

Posted in PTSD | 7 Comments »

 
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