Posted by Dr. Vollmer on December 5, 2014
“Memory is so complicated,” a psychiatrist-in-training, said to me, in talking about the Ferguson case. “Oh yes, doesn’t that explain why cookbook therapies, which only address cognition and not the emotional component to symptom formation are of limited utility?” I say, to a student who looks back at me with shock and thoughtfulness. If we agree that memory is complicated by predispositions, the need to fill in gaps, and social pressures, then can’t we also agree that symptoms such as anxiety and depression are also complete with backstories and family context which make understanding the complexity of the symptom more important than proposing a quick treatment? This is my thesis and this is why I continue to blog. The contradiction between marveling at the many aspects of memory and, at the same time, proposing that deeply held symptoms are simply treated in 12 sessions seems outrageous to me. Having said that if 12 sessions brings relief, I have no issue, but what happens when the patient does not respond to 12 sessions? Do we say they are untreatable? Do we refer them to a higher level of care, such as medication management or hospitalization? No, I say. We should understand that for some people, given the complexity of their situation, more therapy is needed, not necessarily with medication, and not necessarily requiring hospitalization or intensive outpatient programs. Complex brains require complex treatment. At the very least, we should all agree to that.
Posted in memory, Psychiatry in Transition, Psychotherapy | 4 Comments »
Posted by Dr. Vollmer on March 6, 2013
Somehow, in our brains, we have a better memory for feelings then for actual events or narratives. Maya Angelou is right. One could imagine an evolutionary advantage to remembering how someone made us feel in that that memory serves to guide us whether to go forward and deeper into a relationship with them. This information is more critical than the facts of a conversation. I find this “feeling memory” so interesting because these memories serve as tools for future endeavors. Vivian, fifty-nine, married a man who makes her feel as bad as her father did. She finds herself constantly feeling humiliated and “stupid”. This familiar feeling hearkens back to her childhood and yet her narrative memory of her father is one of a man who was “strict”. The memory of her feelings with her father is brought to life through her current relationship with her husband. “Why else would I get myself in this horrible marriage?” She asks me, understanding that her repetition of this feeling of humiliation is a profoundly sad experience for her. When “feeling memories” begin at a tender age, there is often an unconscious continuation of these deep experiences. Understanding these early feelings can break the chain of repetition. Psychotherapy gives hope to this broken chain.
Posted in memory, Psychoanalysis, Psychotherapy | 6 Comments »
Posted by Dr. Vollmer on October 30, 2012
Memory, Freud said, was crucial to mental healing. That which we can remember, we can then “work through” so as to be more realistic in our expectations of others. How then, do we encourage memory in our patients? Originally, hypnosis was designed to pull out repressed memories, like a blunt instrument carving out repressed images, hopefully leading to a catharsis, or a discharge of deeply rooted emotions which could not make their way to the surface without a psychotherapeutic intervention. Freud was unsatisfied with this technique of hypnosis, so he turned to free association as a means of discovering what the person “failed to remember.” Freud said “the forgetting of impressions, scenes, events, nearly always reduces itself to ‘dissociation’ of them. To the lay public, the word ‘dissociation’ implies deep pathology where one has to split off any memory so as to not cope with the emotional sequelae. Child sexual abuse is the common trigger for dissociation, yet here (1914 Freud) is saying that any emotion which overwhelms the ego will be dissociated, and hence separated from conscious thought. Bringing these dissociated thoughts back to consciousness, through the work of therapy which triggers long-repressed memories, allow for the healing between pain and circumstance; this allows for a more meaningful catharsis than one brought about by hypnosis. In other words, integration is the cure for dissociation, since dissociation takes up large amounts of mental energy, thereby hijacking the brain, leading to an obstruction to creative output. With the value on integration, it is no wonder that patients sometimes get worse before they get better. Yet, in today’s society of quick-fixes, it is hard to get patients to tolerate this journey. Herein lies the art of psychotherapy. Sometimes muscles hurt in an effort to get stronger. The brain is no different.
Posted in dissociation, memory, Psychoanalysis, Psychotherapy, Relationships, Teaching Psychoanalysis | 8 Comments »