Shirah Vollmer MD

The Musings of Dr. Vollmer

Context

Posted by Dr. Vollmer on May 6, 2015

Drugs provide symptom relief, so a psychopharmacologist inquires about symptoms and provides medication. Yet, this makes no sense to me. Symptoms occur in a context, in a setting of relationships, childhood attachments and struggles of identity and meaning. If we, as psychiatrists, try to  put symptoms in a framework with personal meaning to the patient, and provide medication which offers symptom relief then we are providing comprehensive care. We must also understand the meaning of the medication for the patient.  On the other hand, if we only focus on symptom relief, we are making our profession narrow and limited. Yes, this is my rant. Yes, understanding context is time-consuming and expensive. And yet, if we do not attempt to help the patient have insight into his symptoms then we are colluding with the world of drive-through psychiatric care. We, as psychiatrists, must care about history, and we must encourage patients to care about that as well. I went into psychiatry because other specialists were too focused on disease and not the person with the disease. Psychiatry offered me a space to explore how the patient integrated his medical and psychiatric issues into the context of his personal story. Each symptom has a unique meaning to the patient, and inquiring about this meaning is the excitement and therapeutic aspect of my work. So, it is obvious why I am saddened that psychiatry, as a profession, has lost this curiosity. Symptoms, quite honestly, are not that interesting. How the patient manages with those symptoms never cease to be fascinating. Drugs are a great tool, as is good history taking. I am going to stick with that, while at the same time, mourn the change in my profession.

2 Responses to “Context”

  1. Shelly said

    I understand where you are coming from, but your patient wants relief from his symptoms. He doesn’t really want to fascinate you. Yes, over the long run, he wants to overcome his issues and to control the symptoms, yet if the urgency brought him to your door, he wants help and help fast. Once he has the symptoms under control, then he (or she, for that matter) might be open to the exploration process.

    • Yes, that is true. Symptom relief is critical to deeper work, but at the same time, symptoms need to be understood as issues which create meaning. For example, a headache could represent a painful psychological state, and yet still be relieved by anti-inflammatories. The idea that a medication helps the symptoms does not preclude the notion that the symptom might be caused by a trigger which at first appears to be absent, but with exploration, the trigger starts to become clear. Thanks.

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