Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for the ‘Guilt’ Category

Quilt of Guilt

Posted by Dr. Vollmer on February 26, 2015

Guilt, that feeling of having done something terribly wrong, an agony, so hard to explain, and yet so powerfully dominating one’s mental existence, is often the essence of mental paralysis and psychic pain. Guilt, the longstanding feeling, often beginning with the failure to make your parents happy, resulting in a longstanding, chronic sense of “being bad” without a narrative to understand this feeling. The lack of a narrative often suggests a preverbal experience in which the person felt frustrated before they developed language and hence it is almost impossible to develop words to describe the feeling. This nonlinear aspect of development, where feelings precede language, is one way of understanding why some people struggle terribly with expressing their feelings, and why some of those who have trouble are mislabeled as autistic, where the more accurate understanding of their limited language is a result of very early trauma.

Conscious and unconscious guilt are the plague of our existence in that the ‘quilt of guilt’ as I like to call it, is woven with both past and present, real and perceived, transgressions. Tyler, twenty-two, comes to mind. He married a woman who his mother disapproves of, and although he loves his wife, he is “massively depressed” because “life never feels right.” His narrative begins with his current symptoms. He does not connect his current discomfort to the agony of being unable to please his wife and his mother, at the same time. By his way of thinking, he has “to live his own life, and it does not matter that his mother is upset with me,” he says, with a tone which suggests he does not quite believe what he is saying. “It seems like your mood tanked right after your marriage,” I say, trying to create a timeline to help us understand the trigger for his mood state. “It is true that I wish I could make my mom happy,” he says, sadly and reluctantly. And so we begin an inquiry into his past relationship with his mom, and how that may or not be connected to his current choice in his wife. We talk about how he negotiated internally that his mate gave his mother grief, and that a part of him did not want to care about that, and yet another part of him, felt deeply troubled by that. The guilt that he feels for making his mom unhappy, reminds him of the guilt he felt when his parents divorced, when he felt that he caused their separation and hence he caused her mom to be deeply unhappy during that time in her life. Tyler begins to wonder if getting married to a woman his mom did not think was good for her, was a repetition of him, in his mind, causing his mother grief, by not keeping his father in the home. Perhaps, Tyler wonders, if he developed the identity of a boy who just cannot please his mother, and in fact, adds to his mother’s stress, and as such, he found a woman who would reinforce this dynamic with his mother.

As we speculate together, we see that his parents’ divorce, in his mind, was a pivotal developmental point which diminished his self-esteem considerably, giving him a sea of guilt which has landed deep in his psychic apparatus. Further life choices are woven into this guilt, creating, what I see, as a quilt, in which each developmental period, another patch of guilt is added on. Our work is to take off patch by patch, to help Tyler see that the divorce of his parents was not his fault, and hence although he might have felt guilty as a child, as an adult, he needs to see their marriage from a different perspective. This new perspective needs to see Tyler as a child who was a victim and not a cause of their divorce, thereby slowly giving Tyler the opportunity to rebuild his self-esteem, with much less guilt left so far down in his psyche.

Posted in Guilt | 2 Comments »

Anniversary Reaction

Posted by Dr. Vollmer on July 19, 2013

A reader writes:” My brother and I were like twins growing up: 14 months apart and inseparable. When I was 25 and he was 26, he died of cancer. At the time, I didn’t grieve hardly at all, as I was raised not to talk about intense feelings much. So…I put a lot of these painful feelings away, and didn’t realize until this past year, when I was going through other stresses, that there was even something called delayed grief. The pain has been overwhelming. I am going through counseling with a really good therapist who is helping, but I am dreading my brother’s death anniversary date that is coming up next month. It is always an extremely difficult month for me. I am especially dreading it this year. I had been doing better lately but the past two days I started crying just thinking about my brother. I miss him so much. He was my best friend in the world and no one can ever replace him. On top of everything else, I have guilt feelings that I didn’t do enough to help him get diagnosed earlier. It has been so many years since he died but it feels like just yesterday.”




In cruising the internet, I found this tale, helping me pinpoint my curiosity about this idea of the “anniversary reaction.” There is something, for some folks, like this reader above, that I will call Zach, in which the anniversary becomes the focal point for grief. It is almost as if Zach’s mind has given him permission to grieve around the anniversary time, whereas at other times, he would feel foolish or “too sensitive”. On the other hand, maybe the anniversary, the time of year, the length of the days, the holidays, bring back a flood of memories which bubble up causing this psychological pain. Either way, and of course, it could be both, Zach expresses this sentiment that “the pain has been overwhelming,” leaving us, the reader, to wonder what he means by that. He is “dreading” his brother’s death anniversary, but what is he afraid of? One imagines that he is afraid of the despair, the heart-wrenching feeling, of helplessness that he cannot bring his brother back. What is “overwhelming,” I think, means that he is fearful that his ego will be taxed beyond it’s typical coping skills, leaving him with no means to soothe himself. In the event that he cannot soothe himself, he fears he will be left feeling agitated and alone, perhaps with a temptation towards conscious or unconscious self-destructive behaviors,  in order to help him escape from his psychological state. All egos, no matter how strong, or well-developed, can face circumstances which exceed it’s ability to find healthy coping skills. On this level, Zach’s fears are understandable. His “good therapist” can help him understand his fears, but by no means, can this “good therapist” protect him from his anticipated need to escape his psychological state. On the other hand, maybe understanding that the ego might, in fact, be stressed in ways that it has never been stressed before, might help Zach be more thoughtful about developing new, and deeper ways of managing, what at this time, seems to be an unbearable reality. Maybe that is what I do.

Posted in Grief, Guilt, Loss, Professional Development, Professionalism | 4 Comments »


Posted by Dr. Vollmer on April 4, 2013

Carrie’s comment of “I can’t complain” speaks to the pain of not feeling entitled to her feelings, or worse yet, guilty for having feelings, at all. The word “can’t,” if substituted for the word “want to” might speak to the meaning of her opening remarks. When I teach, I talk about how listening, by changing words into their opposites, sometimes clarify the person’s unconscious wishes. This luxury of complaining is a sweet event, which allows one to speak negatively, without fear of judgment,  or the feeling that the listener desperately needs to change the subject. Deep relationships allow for this interchange, where the exposure of ugliness, is accepted, knowing that in most social situations, this exposure is condemned. Permission to complain is so rarely granted, that some people, like Carrie, do not know how to expose their negativity, even in a loving environment. Consequently, Carrie lives a life in which she is estranged from herself, and hence from others. Her mental space is consumed with avoiding her “complaining” and so that does not leave anything left over to care for others. If she “can’t complain,” this also means that she cannot tolerate “complaining” in others, as she can only connect with negativity by saying to herself “well, I don’t have those problems.” This parental message, that somehow she is luckier than most, gives Carrie the burden of never feeling the connection, which comes with a shared sensitivity to the world. The struggle of parenting-giving children the message that they are both special, and one of a herd, is the dialectic, which makes the job challenging. Good mental health involves maintaining these opposing points of view: feeling  unique and feeling a member of a  community. Too much tilt in one direction leads to self-esteem issues in which the person either feels so special that he has no peers, or so ordinary that he does not matter very much. Once again, the issue is one of balancing, and titrating feelings, to navigate a world in which one must both take care of oneself and others, at the same time. Carrie is tilted too much towards feeling like she does not belong with the masses because she is privileged. She struggles to have this belonging feeling, but at the same time, she can’t “complain”.

Posted in Guilt | 2 Comments »

“I Can’t Complain:” Shorthand For Guilt

Posted by Dr. Vollmer on April 3, 2013


Carrie, fifty-seven, comes to therapy and says, “I can’t complain,” implying that she feels too guilty to acknowledge the burdens she feels. Her internal script, one that goes back to her early childhood, is that she is born into a “fortunate” family, and all those who were born into other families suffer in ways that she does not, and hence, she has no right to express heaviness or disappointments. Of course, the word “fortunate” is a code word for financial privilege, which, of course, is not a privilege if Carrie is constricted emotionally. “Since when does having money mean that you cannot have negative feelings?” I ask, in order to challenge this family narrative that if one does not have financial woes, then one has no woes. This narrative is mirrored by many impoverished families who recite “well, if we had money, all our problems could be solved.” Superficially, this is obviously a weak thesis. Financial comfort does not save one from the hurt of relationships, or the threat of health problems. Sure, money does ease a lot of burdens, but at the same time, without the appreciation for friendship, for interpersonal connections, and for good health, then money serves families in very limited ways. Since Carrie cannot acknowledge her struggles to herself, she is unable to metabolize them in a way which leads to deeper understanding and compassion. As little compassion was shown to her as a young child, so she exhibits little connection to her emotional interior, and subsequently, her relationships feel shallow to her. Pushing through that guilt is my challenge. This is the guilt in which Carrie feels she is betraying her family story if she “complains,” as she was taught that she could not complain, and even worse, that she was a bad child if she attempted to voice any negativity. I need to slowly and gently unhinge her from this confining notion. The goal-some good complainin’.

Posted in Guilt, Psychoanalysis, Psychotherapy | 7 Comments »

Why ‘The Joys of Parenting’ Gets A Laugh

Posted by Dr. Vollmer on March 21, 2013

Giving parents permission to have negative feelings for their children will always make them laugh. The previous cartoon posts entitled “The Joys of Parenting” are funny because without cloaking disgust in humor, parents feel horrible (code for guilty) when they feel regret about having children. I do not mean the kind of regret where people want to give their children away, but I mean the wistful fantasy of reflecting on life without kids. Even this fantasy can produce so much guilt that parents quickly reassure themselves and others, how happy they are to be with their progeny. Humor bypasses societal expectations allowing a release of negative affect with a smile. In a similar way, sex always sells in comedy shows. Most of us feel awkward about talking about sex, unless we are making a joke, in which case, we know we will get a laugh, again, as a release of tension. This tension, or mixed feelings, results from those sticky feelings of guilt and shame that we all try so hard to avoid, and thereby engage in activities which serve to protest the underlying feelings. As Shakespeare so eloquently stated, “thou does protest too much,” suggesting that underlying the protest is some hard truths. We love and hate our children, our parents, our significant others and ourselves. This cauldron of conflicting feelings challenges us to deepen our sense of ourselves and others. Those who take on that challenge are richer for it, and those who avoid the challenge, compromise the depth of their relationships. Some, who take on the challenge, become funny and charismatic folks, demonstrating a deep understanding of conscious and unconscious feelings. It is easy to get a laugh, once you know the formula for eliciting guilt and shame. Or, as Henny Youngman famously said,  “take my wife–please”.

Posted in Great Quotes, Guilt, humor | 13 Comments »

Car Guilt

Posted by Dr. Vollmer on December 4, 2012

Tony, forty-one, smashed his car. “What does an accident mean?” He asks, saying that on the one hand, he did not mean to crash, but on the other hand, he could have been more careful. “Accident is a relative term,” he continues. “Yes, it is a gray area, in which you did not have intention, but that does not mean that you were not responsible,” I say, creating a spectrum of feelings. “I just feel so guilty,” Tony says, which strikes me as both logical and puzzling at the same time. “You feel guilty because you feel like you did a bad thing,” I say, trying to understand the nature of his bad internal state. “Yea, I am having trouble forgiving myself.” Tony says in a particularly harsh way. “Do you think you should be punished?” I ask, probing for greater understanding of his superego. “Well, I think I am punishing myself. I just feel uptight since it happened.” Tony says that he takes it upon himself to feel tense as a form of retribution for his behavior. “Where does this harshness come from?” I ask, thinking that he has internalized a harsh superego from his childhood. “Yes, my parents were very hard on me when I messed up, but I also think that I would be hard on myself anyway since I do not understand forgiveness.” Tony explains a nature/nurture argument in which he explains that, by his account, he was hit twice. “Forgiveness is a wonderful skill,” I say, helping him entertain this notion as something that he can work on. “Our insurance will go up. We have to get a new car. We are inconvenienced and that creates stress in my family. Forgiveness is not coming easily.” Tony says, outlining his subsequent struggles. “Those are all good opportunities to practice,” I say, trying to help him begin with a baby step. “When you can forgive yourself, you will be better at forgiving others, and that will help you feel more relaxed in relationships.” I say, emphasizing how importance forgiveness is to both self-esteem and interpersonal relationships. “You smashed your call, but you do not have to smash your soul.” I say, highlighting that he is making the experience of his accident much worse by imposing hard negative judgments on himself. “That is a challenge,” Tony looks at me with hopelessness, bordering on despair. “You are up for it,” I say, using words of encouragement, but also understanding how hard forgiveness will be for him.

Posted in Guilt, Psychoanalysis, Psychotherapy | 6 Comments »

Childhood Guilt

Posted by Dr. Vollmer on November 30, 2012

Megan, forty-one, can’t shake the feeling that she caused her parents divorce because she had terrible behavior problems after her brother had a sudden death, when she was four and her brother was two. On the one hand, Megan knows that she was grieving for her brother, and that at such a tender age her grief manifested itself by terrible temper tantrums, but on the other hand, she believes that her tantrums caused so much stress in the house that her father left in order to be with his secretary who had no children. The logic of the situation is clear to Megan. The death of her brother led her father to grieve in his way, which was to withdraw from his family and seek refuge in another life. Megan’s understanding does not change her feeling of deep responsibility for her mother’s subsequent depression. Megan believes that if she was more cooperative during that tender time, then her parents would have stayed married and her mother would not have gotten depressed. “Maybe it helps to think that you could have done something to change the course of history. Maybe that is preferable to feeling completely helpless that your brother died, your parents divorced and then your mom was severely depressed,” I say, pointing out that feeling guilty is often a substitute for feeling helpless. “Yes, but that does not change the fact that I live my life, feeling terrible about myself and my behavior.” Megan says, explaining that in her mind, her low sense of herself all stems from this one extremely traumatic time in her life. “It is nice, in a way, to be able to consolidate your complicated self-image, down to one period of your long and extensive life, where you have done so many things, both good and bad. ” I say, reminding her that even though her brother’s death was a very significant time in her life, she has also done many other things, like get married, build a career, have her own children, which, if she can let those events into her mental interior, might also contribute to her sense of herself. “It is hard to keep the big picture, because I live in fear, knowing that life can change so suddenly. “Yes, managing that anxiety, which for you is so alive, is a particular challenge.” I say, reminding her that on some level all of us understand the uncertainty of life, but that for many of us, we are able to know that without letting that fact crack our core. “I know that I live in the past. I know that my brother died many decades ago. I know that it is particularly hard for me to find peace with that. You are the only person I can discuss this with, because I know that my husband, my friends and my family do not understand my anxieties.” Megan says, explaining to me that she feels alone with her feelings, in part, because she does not feel them to be legitimate. “It is hard to have feelings which go so far back in your life. It is hard for you to feel that is where you are right now.” I say, trying to help her accept where her mind is at. “Yea, I wish it made more sense to me,” Megan says with a heavy heart.


Posted in Guilt, Psychoanalysis, Psychotherapy | 4 Comments »

Parental Guilt

Posted by Dr. Vollmer on November 29, 2012

“I want you to know we have a normal family,” Maureen says to me, as she admits her twelve-year old to the psychiatric hospital for serious substance abuse issues. I did not ask her about her family, so her comment made me pause. You mean, you feel very guilty, I wanted to say, but I did not have the history with Maureen which would have enabled me to speak my mind. “Parental guilt is overwhelming,” I say to my students, thinking about Maureen. “Parents feel guilty, generally speaking, no matter what happens to their children, and when this guilt is added on to things they really feel they did wrong, then they have guilt squared,” I say, trying to explain that a part of parental guilt is about understanding the enormous  responsibility of another human being, whereas another part of guilt could be a knowing negligence when it comes to parenting. “When the guilt can come to the light of day, parents often feel uniquely understood,” I say to my students. “No one wants to talk to them about their guilt. Most well-meaning friends and family want to jump in and quickly reassure the mom that she did the best she could.” I say, emphasizing that the role of a mental health professional who works with children and families, is to demonstrate the understanding of the really difficult feelings which can bubble up during a mental health crises. Reassurance does not help because the parent often feels like their friends do not really understand how deeply bad they feel. Further, the loved ones often do not want to acknowledge the depth of the guilt because it can trigger in the listener their own sense of guilt towards their children. “The default assumption, until you get more information, is that the parent is feeling guilty when they see you.” I say to my students who are  rookie child psychiatrists. “Probing for that guilt is the art of our profession,” I say, thinking to myself that in some ways, this is a lost art, but also hoping that maybe, I and many of my colleagues, are slowly bringing this art back to the field. “No one wants to feel guilty, but worse than that, no one wants to feel alone in their guilt.” I say, pointing out that feeling misunderstood is worse than feeling guilty. “Understanding guilt is tricky, because you need to empathize without agreeing or disagreeing with their own sense of negligence.” I say, emphasizing that understanding guilt is a challenge.  “I hear you,” I respond to Maureen, acknowledging that I hear her statement about her family, but I am also hinting that I understand that there could be a subtext.


Posted in Guilt, Parenting, Psychoanalysis, Psychotherapy, Relationships | 2 Comments »

Privacy vs. Secrecy

Posted by Dr. Vollmer on August 16, 2012

Therapy is a play space, a circumscribed time, a specific place, where ideas can flow without consequences. It sounds like a dream come true for some, and an anxiety laden area for others. Within one person, there are times when both are true. Yet, people carry secrets in which the disclosure, even to a therapist, is filled with guilt and shame. Meredith, a devout Catholic, was having an affair with her male yoga teacher. Her shame and guilt around this activity made it intolerable for her to talk openly about it with me for many years, until ultimately, she wanted to “shine light” on this area of her life. Why did she decide to do it now, I always wonder. Is the “why now” issue a function of a deeper trust in our relationship, or is it that something happened in this affair that she felt like she needed to talk about it, or are both true? “This is a secret within a secret,” I say, highlighting that everything that happens in our relationship is private, or a secret, yet even without this private space, there are deeper private spaces that I am not privy to. This is always true, but in the case of Meredith, this deeper space was pressing on her consciousness causing her to feel bad about herself, yet happy and excited at the same time. The uncovering of these private spaces is the exploration of therapy. The timing and the content of these areas are what make psychotherapy a unique and ever fascinating process. Did I suspect that Meredith was having an affair? Yes and no. I detected a terrible sense of unease about her, such that there was a constant feeling which we discussed, that was pointed towards deep personal discomfort. Is there hope now that this secret has been exposed? Yes and no. Meredith worries that I judge her, even though, the problem is that she is judging herself. On the other hand, she feels relieved in the disclosure. Our work has deepened. We have had a before and after moment. She looks closely at me to detect my reaction. I look closely at her to see how she feels now that she has told me. There is intensity in the room. My job is not to look at the moral or ethical implications, but rather to help Meredith understand how she got here, to help her see how her brain leads her down a decision tree which ultimately has deep emotional consequences. Understanding is my job. Judging is her assumption. As we walk the narrow path between feeling understood versus feeling judged, Meredith might learn to heal herself from her bad feelings. She might begin to repair her relationships with those she deeply cares about. Maybe.

Posted in Confidentiality, Guilt, judgment, Psychoanalysis, Psychotherapy | 4 Comments »


Posted by Dr. Vollmer on April 24, 2012

Lea, astonished me, when she says “I just feel very guilty for how I have behaved towards you,” as she refers to her incessant curiosity about my life. The surprise is not that she feels badly about her behavior, but the surprise is that she chose the word “guilt,” as if she has committed a crime. For the first time, in ten years of seeing her, I began to understand that she grew up feeling guilty about her behavior. Her mother, Carolyn,  was very jealous that Lea was the focus of her husband, Joe’s, Lea’s father’s,  affection. Consequently, it seems that Carolyn made Lea feel guilty for taking Joe away from her. All of these dynamics were subtle on one level and not so subtle on another. Through our work together, this feeling of guilt was reactivated in our relationship, in the transference, thereby illuminating a longstanding feeling which she has absorbed into every fiber of her being. To talk about the guilt she felt as a child is one avenue into this pain, but to reactivate this feeling with me, makes the work feel so much more alive and interesting. It also gives Lea tremendous pain, which we work with in a patient way in which we  peel away the agony in order for us to look at Lea’s history in a more detached way. The emotional pain is important to process, but so is her family dynamics. Lea is beginning to see how she fit into her parents’ marriage in a way in which she was robbed of certain aspects of her childhood. Living with guilt on a daily basis and not understanding the source, was a cause of huge confusion for Lea. Almost within an instance, clarity came.

Posted in Guilt, Psychoanalysis | 10 Comments »

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