What Am I Worried About?
Posted by Dr. Vollmer on October 20, 2015
I worry that patients are over-medicated. I worry that psychiatrists are no longer interested in psychotherapy. I worry that the reductionistic model of most evidence-based practices, takes away from embracing the complexity of the human mind. I worry that I won’t have colleagues to pass down my patients as the residency training is so different, and in my mind, more limiting than it ever has been. I worry that patients will see themselves as “sick” as opposed to the author of their own existence. I worry that the central theme of self-sabotage will be lost when patients seek the medical model of wanting a pill to end their suffering. I worry that medications, although very useful, will change the empowerment of the individual from active to passive. I worry that antipsychotic medications are too often used for behavioral control, furthering the idea that the patient is “sick” as opposed to helping a patient see how they can get well by changing their interface with the world. I worry that children, with well meaning parents, will come to see themselves as handicapped, when, in fact, their issues have to do with separating from their parents. I enjoy prescribing medication and facilitating the relief of suffering, but to an extreme, this becomes me carrying them through the illness, with little work on the patient’s part. Most of the time, the patient needs to do the bulk of the work, trying to understand how he gets in his own way. By understanding this, he can move forward with a new approach to his world. This is transformative change, so much more meaningful than symptomatic relief. Again, symptomatic relief is important, but only as a first step towards a deeper understanding of their trauma and their subsequent preconceived negative feelings that they place on their world. Mental schemas, or scripts, often get in the way of new experiences, which often come in the form of new relationships within both old and new connections. Improving these connections leads to life satisfaction and fulfillment. That is not complicated. Getting there is the challenge. Psychiatrists, if we are to save my field, need to want to help people towards deeper experiences with themselves and others. If we give that up, we will enact the very problem we aim to solve. We will get in our own way.
Shirah Vollmer MD 
pattyspathtohealing said
Not just psychiatrists need to want to help people go deeper, but any person doing psychotherapy. I had a therapist send me to get medication instead of helping me to look at my trauma and how it was impacting my life. She told me it was too hard for me to talk about my trauma and that I could heal without talking about it. I think maybe it was too hard for her to hear, but not talking about it left me with the ever growing shame over this stuff. I needed to talk about it….and how it impacted my life as an adult rather than just get fixed with pills.
Dr. Vollmer said
Hello Pattyspathtohealing!
Yep! I see your point. It makes me sad that therapists punt like that. Listening and containing are essential qualities to a psychotherapist. Medications can interfere with these essential qualities. Thanks for chiming in. My hope is that conversations like ours will make a difference and change the tides.
Shelly said
Many years ago, when I was on a job interview after taking a significant break from working in industry to be home with my kids, an interviewer asked me, “How do you stay current?” meaning “How do I stay up with all the current methods in the field today?” You and I, Shirah, were trained several years ago. Medicine, like industry, is constantly changing–running, flying, in leaps and bounds. It makes me wonder if perhaps the psychiatrists of today are surpassing you using today’s technology and you are worried about things that they aren’t worried about? That maybe today’s psychiatrists know something that psychiatrists who were trained 20 or 30 years ago don’t, and therefore aren’t worried?
Dr. Vollmer said
Interesting, Shelly, but I do not think so. Technology is indeed revolutionizing medicine, but to date, it has not impacted psychiatry. I am a minority, but not completely alone with my concern for the future of psychiatry. Listening is still a valuable healing tool. If we lose that, we have lost our way. I do not see any way around that. Thanks.
Eleanor said
I am all for the new and amazing technological advances being made in all areas of medicine today…..There are 3 neuroscientists, an orthopedic surgeon and an OB?GYN in my family and I have seen the changes over time in all these areas and more. I also have been listening to interviews with Dr. Mark Solms, psychoanalyst and neuroscientist from South Africa and he is doing fascinating work in these areas. Am also watching the PBS series on “The Brain” by Baylor neuroscientist, David Eagleman…..fascinating. In addition, had it not been for the complex medical technology 20 months ago when I had a nightmarish emergency when my heart was accidentally punctured during an elective catheter ablation, I would be dead…period. The ECMO cardiologist (who is also on the heart transplant team) that hooked me up to the ECMO (heart lung bypass machine) told my son he’d never seen anyone so close to death as I was, and when he hooked me up “I came right back” so they could transfer me to emergency surgery for repair. Maybe today there is technology that could have saved my daughters life ….who knows. So yes advances are brilliant!! With that said, I have to say I don’t even want to think what my condition would be today had I not had an analyst that could help me understand where my severe symptoms (paralyzing panic and others) were coming from and being acted out with my present day family waaayyy back when, after my daughter was born with Spina Bifida and all that that entailed over her life span of 21 years (symptoms that belonged in my childhood)…..I don’t even want to think what things would be like had my daughter and I not had talented psychoanalysts (yes, for many years). In addition, I was helped to understand the humanness and love and kindness (along with their faults) in my parents who made mistakes…..originating from difficulties in their own childhoods…….We were all “humanized”………To my knowledge, there are no mental health treatments, other than a psychodynamic approach, that can accomplish this. I hope there are a few psychiatrists reading your blog Shirah. The people in training need to hear stuff like this…As Mark Solms put it…..the psychoanalytic approach is the best way to understand the subjectivity and complexities of each one of us…we are all different and treatment needs to be individualized!!
Dr. Vollmer said
Thank you Eleanor. I would add to your comment that treatment needs to be individualized, which sometimes means appreciating the power of understanding and containing, which means the power to do nothing other than listen, is indeed therapeutic, and as such, technology, psychopharmacology, and other interventions can serve to sabotage the treatment. If a patient needs a caring listener, and, as Pattyspathtohealing comment illustrates, the therapist quickly turns to “fixing” the problem, then the patient is denied the opportunity to sit with his/her feelings and cope with that. This discussion reminds me of the stereotypical marriage in which the wife wants her husband to listen, and he wants to tell her what to do to fix the problem. The stereotypical wife is wise. She needs to be listened to and then she can move on. With deeper psychological pain, that principle often holds. Thanks Again!