Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for February, 2014

Present or Future: How Do You Decide?

Posted by Dr. Vollmer on February 27, 2014


Balance is the point, and yet, the struggle to live in the present versus the future is palpable for some. How much do you save for retirement, versus enjoying your money now? How much should a twenty-something enjoy their youth versus setting up a career path? This dilemma, leaving out the glaring issue, of those who live in the past, who do not stay current with today’s culture, can create a clash of values. Classically speaking, parents want their kids to secure a future, whereas young adults often make the present more important. Is this a generational issue, or is forward-thinking a necessary developmental step towards a deeper existence? On the other hand, is living in the present a skill which too many ambitious people lack? Is it admirable to enjoy life, even if the future seems precarious? Samantha, thirty-five, comes to mind. She loves her life. She has nice friends and she works as a nanny, loving the children she sees five days a week. She has no mind for a career, but she is bright and well-educated.  She is financially independent and proud of that. She wants children, but she thinks that “will happen” without much thought that she is not married, and her eggs are ticking. Samantha’s issue? Her dad disapproves of her life. He wants her to have a career, a husband and a baby. Samantha feels dismayed by his disapproval, but not enough to change her life, but enough to enter into psychotherapy. “Maybe you care what your dad thinks, because a part of you agrees with him?” I say, wondering why her dad’s impressions are so important to her. “Well, yes, of course I agree. I know he wants good things for me, but I am happy and why should I change that?” She asks, as if there is no good answer. “Because life is a juggling act between present-day happiness and preparing for a future,” I say, reminding her that forward-thinking is universally beneficial, but too much, like so many things, is detrimental to mental health. “OK, so I am not juggling that right now. I guess I should but I repeat that I like my life and see no reason to change it.” Samantha says ardently. “Well, that would make sense, except you are here with me, because something does not feel right,” trying gently to access her distress, as “I like my life” although true on one level, is also a defense, on another. “Maybe you are scared to think about a future,” I say, understanding that the future could be a very scary and uncertain place in Samantha’s mind, and so she may be avoiding that challenge. “Of course,  I am,” Samantha says, as if it were obvious. “Of course, you say, but I was not sure you were in touch with that feeling,” I say, meaning it was not obvious to me she was aware of feeling that way. Samantha and I are on our way towards exploring her future fears. Her father, probably, has done her some good, by igniting the anxiety associated with paternal disapproval. Our journey has begun.

Posted in Psychoanalysis, Psychotherapy | 2 Comments »

Immaturity or Anxiety: Development or Psychopathology

Posted by Dr. Vollmer on February 26, 2014


Growing up involves making major life decisions which, if one pauses, can create tremendous anxiety and insecurity. When is a person trying to grow and when does a person have an anxiety disorder? As with all of psychiatry, the distinction is subjective, and so my rant begins.  I all too often see people who need to grow up, but are labeled with an anxiety disorder, and hence their self-assessment turns to one who is “ill” rather than one who has to meet the challenges of development. Cullen, fifteen, female, comes to mind. She paces, she skips meals, she sleeps poorly, and she has been on multiple psychotropic medications, for a diagnosis of generalized anxiety disorder. “Maybe you need to learn some coping skills,” I suggest. She looks at me stunned and appreciative. “Wow, that really makes sense to me,” she says, to my surprise. Cullen seemed to instantly respond to the idea that life is stressful and she is opting for coping mechanisms which detract from her objective of budding autonomy and self-sufficiency. The change in frame from “victim” of illness, to “agency” over stress was remarkable, despite my decades in practice. Cullen gravitated quickly towards inner exploration and deeper work. I stopped her “anti-anxiety” medications, as it seemed like she could navigate tough waters with thought and reflection, rather than with sedation. Usually, I think in baby steps. Cullen took a big leap. I hope for incremental change, but Cullen had a transformation. My surprise invigorates my work. Humans always amaze.

Posted in Psychotherapy | 7 Comments »

Hyperbole: Why?

Posted by Dr. Vollmer on February 24, 2014,0,2093443.story#axzz2uHGk9ei3


As the Oscars approach and I read this article by Charles McNulty, I suddenly felt understood. Why do people need to say “the best” frequently, thereby invalidating their point? There is the concept of a recency bias, where we are prone to exaggerate our most recent experience, and hence the last movie we saw is often “the best”. Narcissism is at play as well. We want to believe that we have exceeded our previous experience, thereby making this particular event “special” and us, special, by association. This strong need to feel like we have had a uniquely intriguing experience is how corporations make loads of money by both personalizing and making the activity feel exclusive. Exclusivity, specialness, sells. Narcissism licking, is another phrase which comes to mind. If I can stroke an ego, I will be liked. This is simple marketing. Understanding narcissism does not just help us develop more intimate relationships, it also helps us exploit them, if that is what we so desire. Not understanding narcissism creates a vulnerability of being “played”. Marla, of Monte-Marla comes to mind. She needed flattery so much that she could not distinguish between “sucking up” and true appreciation such that she could not discern between genuine gratitude and the need to please. This distinction is critical towards understanding the unconscious need to please, resulting in a tendency towards hyperbole. Genuine gratitude comes from a deeper, meaningful place, which feels vastly different than the hyperbole resulting from a deep need to please others. This distinction, although subtle to some, is important in the long-game of relationships, as over time, deep appreciation persists, whereas the need to please turns into resentment and anger. More case examples to come. Stay tuned.

Posted in Musings, Psychotherapy | 6 Comments »

NYer Cartoon Contest

Posted by Dr. Vollmer on February 24, 2014

                                 It is the elephant on the bridge.

Posted in Cartoons | 2 Comments »

Success Stress

Posted by Dr. Vollmer on February 21, 2014

Ollie, twenty, just sold his company for many millions of dollar. He is an overnight sensation resulting in insomnia, massive amounts of attention and problems in his relationship. He is happy and confused and deep down, he says, he wants it all to “stop”. “What is the “it”? I ask, not sure what he means, but understanding that he is feeling flooded and I am suspecting that he wishes he could modulate the massive amounts of emails he is receiving. “I sorta want to go back to my old life where I did my thing and no one bothered me,” Ollie says, seeming to appreciate the privacy of our relationship and the ability to confess that although everyone assumes he is ecstatic, in point of fact, he is stressed. “It is hard for people to feel sorry for me right now,” he says, with humor and truth. “I bet your mom gets it,” I say, knowing that his mom expressed to him concern over his meteoric rise. “Yea, but what am I going to do, cry on my mom’s shoulder right now. I am trying to keep a brave face for her, as I dropped out of college and she was really frightened for me. I want her to think that I have arrived, even though I am not sure how happy I am with my new role of managing a lot of both wanted and unwanted attention.” I begin to ponder the change from technological wizard to business person, at the tender age of twenty, with no college education, but a hope to make a product that someone cared about. I know this is a common story these days, as our world is heavily rewarding technology, meaning that technically savvy young people can soar, whereas those without technological skills are often scrambling to get by. This divide has created a youth culture, it seems to me, where there is what I would call the “youth gap,” the divide between those young people with more money than their parents, versus the young people who struggle and often have to move back with their parents. Both groups have emotional struggles, but for different reasons. “It seems to me, that you are forced to switch from nerdy mode to business mode, and that transition is very challenging for you right now.” I say, thinking that Ollie is so young to be thrust into a world of the “bottom line”. “Yes,” Ollie says enthusiastically. “I want to go back to being a nerd.” Oh, the world has changed, I think to myself, and yet the emotional struggles of transition are the same. All transitions are difficult, even those which seem, to many, to be a dream come true.

Posted in Psychotherapy | 2 Comments »

Calendar Relationships

Posted by Dr. Vollmer on February 20, 2014

How much in advance do you know your calendar? How often do you double book or get confused? Do you use technology to assist your scheduling? On the one hand these are very practical questions of daily life, but on the other hand, they can represent one’s relationship to one’s life. How one reacts to looking at his calendar intrigues me. Some have joy. Some have dread. Some only focus on the non-work activities and vice versa. Mia, seventy-one, comes to mind. She lives in a constant state of confusion. She runs late. She double books and she tends to blame others for her failures. “Maybe you do not like what is on your calendar so you do not want to get to close to it, to avoid feeling like you are not happy with your life.” I say, thinking that Mia is a very intelligent, very focused person, who is perfectly capable of managing her time well. “That could be,” Mia says with anger and frustration. “I don’t like most of what I am doing, but I don’t know how to change that,” she says with a firm and angry tone. “Getting out of confusion and blame is a good first step,” I say, helping her see that sabotaging her life is not a good step towards change. “Yes, but I don’t think I will be able to change my life, at this late age,” Mia says, as if I do not know how old she is. “What makes you say that?” I challenge her. “I have had these habits for a very long time.” Mia says quietly. “Yes, I understand that. We have a long journey, but we can begin.” I say, both understanding that with age, changes are slow, but with patience, Mia can pivot to a place where she looks at her calendar with excitement instead of confusion.

Posted in Psychotherapy | 2 Comments »

Happiness and Flow

Posted by Dr. Vollmer on February 19, 2014

“In his seminal work, Flow: The Psychology of Optimal Experience, Csíkszentmihályi outlines his theory that people are happiest when they are in a state of flow— a state of concentration or complete absorption with the activity at hand and the situation. It is a state in which people are so involved in an activity that nothing else seems to matter.[8] The idea of flow is identical to the feeling of being in the zone or in the groove. The flow state is an optimal state of intrinsic motivation, where the person is fully immersed in what he is doing. This is a feeling everyone has at times, characterized by a feeling of great absorption, engagement, fulfillment, and skill—and during which temporal concerns (time, food, ego-self, etc.) are typically ignored.”

“In an interview with Wired magazine, Csíkszentmihályi described flow as “being completely involved in an activity for its own sake. The ego falls away. Time flies. Every action, movement, and thought follows inevitably from the previous one, like playing jazz. Your whole being is involved, and you’re using your skills to the utmost.”[9]

These are the words of Dr. Mihaly Csizszentmihaly, a psychology professor at Claremont Graduate University. I gravitate to his ideas, as opposed to Dr. Gilbert,, because as “the ego falls away” happiness can be felt. The full engagement in an activity, with the right challenge/skill balance enables a person to have that rare experience of living in the moment. This is the argument for “positive addictions” like exercise or computer games. The ability to fully immerse creates an energy and vitality, rarely experienced while one is planning for the future or anxious about life’s traumatic events. This vitality can then be leveraged for a greater “immune system,” to quote Dr. Gilbert, when stressful life events pop up. The positive addiction can serve as a means of coping, a means to remember and experience that one’s own brain, one’s own body, can give oneself pleasure and pride. This “addiction” creates the “flow” that Dr. Csizzentmihaly describes.

Lee, forty-one, the mother of Hugh, sixteen, is worried that Hugh is playing too many videogames. “Does he have friends?” I ask, trying to figure out if the videogames have narrowed his social interaction or expanded them. As we explore Hugh’s life, his friends, his academic performance, his other hobbies, it seems that Hugh is using videogames as a means of having fun, of enjoying the challenge and the thrill of a virtual space. Hugh, I might argue, is enjoying his imagination, which, in his case, is stimulated by the role-playing games. It is possible that Hugh is having the “flow” and so maybe, just maybe, the videogames are a positive part of his development.

They are helping him learn to love his brain, to live in the moment, and explore ideas that are exciting and innovative. Videogames, as play, as “flow” could, in fact, be the key to his success in life. The confidence created in trusting how his brain gets him to a higher level in a game, could be the forerunner to the confidence he needs to land the right job, and feel creative and satisfied. “Maybe you should buy him some more games, ” I say, emphasizing my point about the potential developmental enhancement of some videogames. Flow is my new word. It is a great way to conceptualize the value of immersion. Sometimes the world turns to a better place.

Posted in Happiness | 10 Comments »

Angry Listening

Posted by Dr. Vollmer on February 19, 2014


“I think you are too angry to listen,” I say to Kerry, sixty-six. “Wow, that is interesting,” Kerry says, stunned at my comment. Her epiphany followed. “I never thought about that before, that when I am upset, I can’t take in new ideas.” Kerry says, as if the kaleidoscope just formed a picture. Receptive listening involves a calm state of mind, I think to myself. Floating ideas, however vague, or imaginary made Kerry so fearful that she began to yell at me for helping her think about ways to navigate her future. Kerry is in transition. Her husband died suddenly, leaving her with surprise debt, and thereby needing to make major lifestyle adjustments. On the one hand she knew her anger towards me, was really about something else, as on the surface of things, I was not offensive, but on the other hand, she had trouble expressing anger to her deceased husband, so her anger had to come out somewhere. “You know you have been telling me I am angry for a while now, and I am angry, at myself, for not taking more notice of our financial situation.” Kerry says with sadness, anger and fear. “Maybe you are also angry at Leo (deceased husband),” I say, helping her to accept contradictory feelings. “I can’t get angry at him. He did not plan on dying. How can I be mad about that?” She says with confusion and pain. “He withheld information from you about very precarious financial investments, leaving you to have a financial reversal, so I think you have some feelings about that.” I say, trying to parse out the multiple layers of feelings that Kerry has towards Leo. “When you are angry you then feel guilt about your anger, leaving you in a paralyzed place where you are unable to think about how to move forward.” I say, outlining a hypothetical mechanism in which her emotional state prevents her from moving into a contemplation phase over her next chapter. “I just don’t see how getting mad at Leo helps me,” Kerry says tearfully. “Knowing how you feel will help you.” I say, stating the obvious notion that first Kerry needs to identify her feelings so that she can begin to metabolize them. “It will help you listen,” I say.

Posted in Psychoanalysis, Psychotherapy | 2 Comments »

Impact Bias

Posted by Dr. Vollmer on February 18, 2014

Dan Gilbert

A “psychological immune system” is what Dr. Gilbert terms the mechanism about how we cope with adversity. “We synthesize happiness,” he says, implying that we frame events in our lives in order to feel happy.  He cites the story of a man who was wrongfully in prison for most of his life and then describes the prison as “glorious.” This TED talk got me going towards this post, as I found myself talking back to the podcast. What people say and how people feel are two different things, I wanted to say. There is the manifest content, what is expressed, often representing wishes and fears, which are part of the latent content. In other words, asking people if they are happy is not a useful exercise, as happiness is an affect which has layers of complexity and ambiguities, and hence not amenable to a yes or no question. We do not “synthesize” happiness,” we experience meaning, closeness, a sense of importance, joy, humor and relaxation, and with those feelings comes happiness. Self-assessment of happiness is also not the best measure as it presumes that people know how they feel, which, to my way of thinking, is not always so clear. Understanding one’s mental state is a challenge for many, and so the answer to the question about happiness is subject to the “living in wishes” experience that I have blogged about previously. How to obtain happiness is an interesting question. I do not think Dr. Gilbert is helping us towards that answer.

Posted in Happiness | 3 Comments »

Holiday Songs

Posted by Dr. Vollmer on February 17, 2014

Some gifts make me laugh. Thanks.

Posted in Media Consumption | 1 Comment »

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