Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for February 19th, 2015

Treating Confusion

Posted by Dr. Vollmer on February 19, 2015


Struggling to define what I do, to describe who I treat, and whether I see my patients as mentally ill, I have come to see that mostly, by no means everyone, I work with confusion and psychic pain. Do I think that everyone with psychic pain is mentally ill? No. Do I think that confusion can be measured, such that Big Data can monitor my “progress”? Of course not. Do I think that confusion is deeply personal and layered deeply with both conscious and unconscious layers? Of course, I do. Does medication help with psychic pain? Yep. Does putting someone one medication mean they are mentally ill? Of course not. Being psychically bruised is not the same as mental illness. Taking medication for a bruise makes sense. Labeling someone as mentally ill does not.

On another level, my field is also confused, just like my patients. We cannot define our terms, and we cannot establish indications for treatment, or modalities of treatment which create lasting change. We are desperate to measure something, even if what we measure has no inherent value. We hold hope for neuroimaging studies and pharmacogenomics to give us more objective evidence of what we are treating, and we seemed shame to say that we are as confused as our patients.

I advocate for embracing our confusion as a way of coping through life’s challenges. Confusion, although psychically painful, also leads to exploration and discovery, as Freud taught us years ago. He described understanding the mental apparatus like an archeological dig. We do not know what we will find, but the fun is in the adventure of not knowing, and being open to seeing things. Yes, inquiry into the workings of the mind is fun, while at the same time, it is layered with challenging feelings of guilt and shame.

Finding a path in life which feels fulfilling, connected and warm is a never-ending challenge, as one cycles through the stages of development, both one’s own development and those they love. The dynamics of aging, combined with the dynamics of mental processes create a constantly changing landscape in which to make meaning and happiness. Like all other endeavors, there are times when one’s personal navigation tools fail, and so this presents  an opportunity for new tools and new ways of understanding the world.  I help with that. That is what I do.


Posted in Psychoanalysis, Psychotherapy | 4 Comments »

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