Shirah Vollmer MD

The Musings of Dr. Vollmer

“Introspection is always retrospection” (Sartre)

Posted by Dr. Vollmer on April 17, 2015

“Introspection is always retrospection.” One cannot think unless one reflects on previous experiences and hidden pathways to current feelings and motivations. Trauma and Evie come to mind. Evie witnessed her brother get shot in the back by a policemen. Since that fateful day, when she was thirty-two, Evie was a changed person. At first she was numb and went through the motions of life, caring for her young children. Then, what seemed suddenly, she became depressed and suicidal. Suddenly after that, she bounced into an enthusiastic and highly creative and energetic behaviors. Did Evie, at the age of thirty-two have an onset of Bipolar Disorder or is all of her behavior explained by trauma, or is there some combination? If one just looks at current behaviors, then Bipolar Disorder might make sense, but in the context of a major trauma, PTSD might also make sense. How much retrospection is necessary to diagnose psychiatric illness? Can symptoms be taken out of context to give someone a life long diagnosis? Is the only reason moods change suddenly is secondary to a bipolar disorder? Can sudden mood shifts represent an instability of personality due to either recent or past trauma to the soul? The value of retrospection, searching for past clues, to explain current behavior cannot be overstated. Triggers of abnormal behaviors can be recent or buried in the past, arising in one’s mind as a painful memory, long suppressed, but now coming to light. Do we need to bring Philosophy into psychiatric training to remind trainees that the mind is more than a series of chemicals which can be altered by medication? Do we need to bring Humanism, the concept of the everyday struggle for meaning, and importance, into the mind of the psychiatrist who may be very trigger happy to diagnose and treat, before carefully considering the landscape? Just as the police officer pulled that trigger way too soon on Evie’s brother, maybe psychiatrists, in a similar fashion, are too quick to judgment. With time and careful thought, understanding can happen. People, like Evie’s brother, and Evie, can be humanely treated and brought to a place of compassion and growth.

6 Responses to ““Introspection is always retrospection” (Sartre)”

  1. Shelly said

    Yes, yes, and yes. We do need to bring Humanism into the mind of the psychiatrist when he/she is considering diagnoses. On the other hand, given today’s landscape of needing a quick diagnosis without the luxury of taking all the time necessary to consider all the facts and stressors in one’s life before coming up with a label, I doubt that psychiatrists and other mental health professionals will actually do that. Like the policeman who needs to make a quick judgement call before pulling the trigger, psychiatrists will have to decide to medicate and treat without thinking of all of the outside factors that could be making a patient behave a certain way. At least that’s the way I see it.

    • The issue of trauma needs to return to the diagnostic framework. To understand trauma takes time and patience. You are right in that a quick history with long intervals between follow-up appointments lend themselves to hasty treatment, and mismanagement. By bringing Yalom’s work to greater public attention, I am hoping that the complexity of mental life can return to psychiatry. As you know, this is a large reason that compels me to blog and get the word out, so to speak. Thanks.

  2. Eleanor said

    Shirah your first comment on this blog…, below, says it all in short form.

    “ ‘Introspection is always retrospection.’ One cannot think unless one reflects on previous experiences and hidden pathways to current feelings and motivations.”

    Just what percentage of the lay public is aware of this indispensable necessity in understanding their world?….what percentage of incoming psychiatrists? …how many therapists specializing in various behavior oriented treatments? Certainly psychoanalysts are aware in spades, but folks who need mental health help are not, to my knowledge, standing in long lines at your doors. Most people I’ve know through the years aren’t even aware there are “hidden pathways”. I know I wasn’t, to any great degree when I initially sought psychoanalytic help many years ago after the birth of my daughter with Spina Bifida.

    My experience has also been that most (not all but most) don’t want to know about our “hidden pathways”….our all to human dark side if you will….to be aware is difficult for all of us. I’ve said it, but will say it again, it’s not just the time in treatment that’s valuable, but the lifelong lasting therapeutic benefits psychoanalytic methods have on the psyche and the ability to continue to think and rethink these pathways if necessary. As you mentioned in an earlier blog….”it’s a huge commitment of time and money, for which the dividends pay every day of my life”. When are others, including incoming classes of psychiatrists going to get this idea of the importance of “retrospection”?

    • Thanks, Eleanor. The motivation for becoming a psychiatrist, both conscious and unconscious are changing as the field shifts away from good history taking and towards more rapid assessments and treatment decisions. Having said that, there is still a vocal minority of psychiatrists who deeply care about the complexities of human behavior, and as such, want to spend time and thought with people in an effort to heal deep wounds. The more you and I dialogue about this changing landscape in psychiatry, with an understanding that there is still room for deep treatment, the more there is a chance that at least a subset of psychiatrists will carry the torch of psychoanalytic and humanistic thinking. Thanks.

  3. Janet Wise said

    As a non-traditional student, finishing up my undergrad studies in Psychology and Gerontology, I was more than a little alarmed to see that a majority of my fellow “traditional” students seemed to think that the future of psychology is biological. Now, I think a lot of that was due to the exceptional Biopsych teacher we have, but the majority of my emphasis is definitely philosophical. It seems we have forgotten the history of our “being,” apart from what our physical bodies do. I elaborated on this philosophical aspect in terms of social work in my capstone presentation. The students seemed to be surprised at the rich knowledge we already have about psychology from its philosophical roots, and there was a lot of head-nodding from my instructor. After the experimental context of “introspection” introduced by Wundt, Watson’s denunciation has seemed to put the whole term to rest. Sure, cells have intelligence, but can we ask them why they do what they do?

    • Hello Janet Wise and thank you for chiming in. I think that the future of psychology in Universities, at the moment, does tilt towards the biological, but the hope is that psychoanalytic ideas, or issues of motivation in general will be taught in the Humanities department. I think it is likely that there will be a home there for those who are curious about the complexities of human behavior. Thanks again.

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