Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for November 20th, 2013

Self-Imposed Prison

Posted by Dr. Vollmer on November 20, 2013


Time, intensity of mutual effort and courage are the major ingredients in getting out of self-imposed prison. Roony, thirty-three, female, is “never satisfied with the therapy,” as she likes to tell me. “Maybe this dissatisfaction hearkens back to a life-long frustration that you could never feel free to do what made sense to you, but rather you had to care for your five younger sisters,” I say, feeling Roony’s endless sense of not getting what she needs. “You have put yourself in a box, and now you are mad that you can’t get out,” I say, again shifting the notion that she is not a victim, but rather a perpetrator of her own unhappiness. “I can imagine that you were in a tight corner growing up, with few choices, but now that you are an adult, you have many choices, but you are carrying forward the drudgery of your past.” This well-worn concept that the past invades the present speaks to my therapy with Roony. The feeling from the past, her frustration with her life, is carried forward into my office. Yes, my critics would say, that I am getting myself off the hook, that I am not looking at how I could make the therapy more satisfying for Roony, but to that, I would say, that this is not a binary experience. I am focusing on one plausible aspect of her unhappiness. Albert Mason MD calls this the “pathological superego” where Roony’s rules for her life give her misery and bitterness, but she disavows that the superego is within, so she experiences it as an unhappy situation, which is “put upon her”. This “pathological superego” is a model for depression, where the individual feels despairing, but does not see that the despair stems from negative self-assessments. Roony is unemployed, which she could see as an opportunity for new experiences, but instead, she feels her unemployment as a validation of her sense of failure. Sure, there is a dance between external limitations and internal feelings, but with Roony, her internal feelings dominates her external world. In other words, she feels life to be limited, and then it is. Working from within, her understanding of her opportunities, her ability to make herself a better life, her ability to be free of her past burdens, gives us hope that with our work together, Roony will find the key to get her out of her box.

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