Shirah Vollmer MD

The Musings of Dr. Vollmer

Ferenczi, An Attitude, So says Andre Haynal: A European Analyst Hits the LA Scene

Posted by Dr. Vollmer on January 11, 2016

How do I come back to my blog in 2016? How do I not repeat my plea that psychiatrists need to return to history-taking, active listening, and thoughtful consideration of diagnoses, before plunging into the psychopharmacological rabbit hole, where patients do not know who they are or what their problem is, but they are stuck on medications which make them wonder if they, or the person who encouraged them into the mental health office, are “losing their mind.” How do I express my passion for pharmacology which sits next to my passion for understanding and explaining the inner workings of a complex mental apparatus, shaped by years of experiences, and in particular, early vulnerable experiences which lay down a foundation of neural networks which can be re-wired with monumental effort, but there are no short-cuts.

I return to my psychoanalytic roots, my training which promotes the dyad, the relationship between doctor and patient, hoping to return to the comfort of the womb, only to be reminded that my imaginary “womb” is also troubled. The doctor/patient relationship is essential for healing, any healing, but at the same time, the power differential in that relationship needs to be understood and appreciated. Patients are vulnerable, as is the physician, but there is an important asymmetry here. Patients can be persuaded to harm themselves, so often evidenced by the seduction of the patient, leading to the patient as re-victimized as a sexual object.

Once again, I find myself in this middle band, the band in which the 15 minute psychopharmacological appointment seems greedy and inappropriate to me, while at the same time, the intense psychoanalytic relationship can be used to feed the narcissism of the analyst at the expense of the patient. There is a middle band, but it is lonely and thinly available to me, in terms of like-minded colleagues. This has been my challenge, my point, in post after post.

Sunday, I immersed myself, or re-immersed myself, I should say in a psychoanalytic historical lecture about Sandor Ferenczi MD, the Hungarian psychoanalyst who was one of the many proteges of Freud, before he was ex-communicated. In the early 1900s Ferenczi promoted the idea that the doctor and patient are both flowers, sitting together trying to understand one another. There is free association on both sides, he would say. André Haynal MD, a swiss psychiatrist/psychoanalyst explained Ferenczi in historical context, allowing me to propose that while Ferenczi thought he encouraged free association, perhaps he encouraged the patient to feed Ferenczi’s narcissism, to make the analyst feel good, and in so doing, the patient repeated early trauma of sacrificing oneself for the other. Dr. Haynal appreciated the discourse, and a lively discussion ensued. I found myself pathologizing a great forefather in my field, knowing the possibility that one person’s great psychoanalytic treatment could be another person’s narcissistic feeding frenzy. In other words, treatment is not measurable, but ideas are worth struggling with, to deepen understanding.

With age, I see the multiplicity of ways in which scenes can be interpreted. One person’s mental illness is another person’s creative expression. The lines are blurry. I embrace that uncertainty. Now, I need to find peers.

2 Responses to “Ferenczi, An Attitude, So says Andre Haynal: A European Analyst Hits the LA Scene”

  1. Shelly said

    Do patients really try to understand the doctor? Or do they try to clarify themselves so that the doctor can understand them? They put themselves in the doctor’s shoes and listen to themselves speak, and realize (or not) that they are not making sense, but they don’t really try to understand where the doctor is coming from. They think that the doctor is all powerful and can make them well. That’s why they come back, time after time. Is it not true that after the first appointment with a psychiatrist, the psychiatrist generally prescribes medication? Isn’t it rare that he/she simply prescribes talk therapy as the cure?

    • Shelly your question so embodies my quest to re-establish psychiatry as a field that listens deeply and thinks about relationships, both the relationships the patient has in his life and the relationship he forms with his psychiatrist. The relationship to authority, to understanding how one interprets the “all magical doctor” experience speaks volumes to the patient’s history and “attitude” about his world. Yes, today’s psychiatrists think about what medication the patient can take with them when they leave the appointment, and in so doing, they foster this sense of authority and omnipotence, whereas before Prozac, psychiatrists took time to understand and worked more as a “fellow traveler” in the journey towards wellness. This drastic shift has been very sad to me, as I both appreciate the value of medication, while at the same time, feel very humbled by suffering, and as such, I want to listen and try to understand the confusing space of psychic pain. Psychiatrists have lost their way. They have embraced authority in exchange for humility. This stance will hurt the field for many generations to come. I am taking the long view and hoping we can eventually get back on track. Thanks, as always.

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