Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for the ‘Musings’ Category

These are my main blog entries.

Professional Update

Posted by Dr. Vollmer on November 14, 2019

https://www.pri-med.com/globals/faculty/v/vollmer-shirah

https://www.n-c-p.org/

My professional life is absorbed with educating clinicians about mental health, mental suffering, mental illness and various modalities of treatment for those who suffer. In addition, and most of my time, is spent face to face with patients, struggling with them as often as they want to, with difficult issues of guilt, shame, inhibition, as well as the disappointments one has with oneself and with loved ones. The purpose of this therapeutic pursuit is to create deeper authenticity and thereby increasing vitality and flexibility as life throws curve balls, time and time again. Through these various activities my professional life is woven together with the strong commitment to bring “old school” models of care, in-depth psychotherapy, combined with “new school” models which include psychopharmacology and neuromodulation technology. Listening to patients continues to be a lost art; one which I actively try to bring back to both primary care clinicians and to mental health clinicians. I sharpen my own listening tools on a daily basis, as my patients present me with new material which requires me to listen deeply and hear new themes as each day presents new therapeutic challenges. I could not teach if I did not treat patients and feel the front-line, and I could not treat patients if I did not continue to stimulate myself with creative ways to teach. In other words, teaching keeps my therapy skills alive, and therapy keeps my teaching skills alive. I am grateful for both opportunities.

Posted in Musings | 2 Comments »

Let’s Talk Depression…A New Talk for Pri-Med

Posted by Dr. Vollmer on September 12, 2019

youtu.be/P8YvikpCZtQ

 

 

Pri-Med East

Boston, MA | December 4-7, 2019

Boston Convention & Exhibition Center

Agenda

Wednesday, December 4, 2019
Thursday, December 5, 2019
Friday, December 6, 2019
Saturday, December 7, 2019

Wednesday, December 4, 2019

CME IconCME accredited session

Syllabus slides available for download

Session available On Demand

Ticketed Events

Add Ticketed Events to your itinerary as early as 8 weeks prior to the conference during registration or by logging into the Registration Resource Center. Ticketed Events include Industry Theaters, Clinical Training Programs, and Hands-On Workshops during session breaks.

7:30 AM – 7:45 AM

Welcome and Opening Remarks

CME Icon
Neuro/Psych

7:45 AM – 8:45 AM

Let’s Talk About Depression: Recognition and Management

Speaker: Shirah Vollmer, MD

Hem./Onc.

7:45 AM – 8:45 AM

Colon Cancer for Primary Care

Posted in Musings | Leave a Comment »

Machines For The Mind

Posted by Dr. Vollmer on July 30, 2019

😇😇😇

Transcranial Magnetic Stimulation….the neuromodulation device FDA approved treatment for depression. Trigeminal Nerve Stimulation..the neuromodulation device FDA approved treatment for ADHD in 7-12 year olds. Cervella, the neuromodulation device, FDA approved treatment for depression, anxiety and insomnia. All of these devices deliver electrical current to the brain/nerve endings via an external device. The mechanism of action, like antidepressants, is not known. The theory is that neural networks need a re-boot to treat psychic pain. These machines help us move away from the “chemical imbalance” theory to a “neural network malfunction” theory. Of course both mechanisms could be at play, but we do not know that yet. We know that FDA approval hinges on beating the placebo response, but we also know that all psychiatric illnesses have a high placebo response. My point is that we come from a place of humility, of not knowing how we help people, and yet, trying all of our tools, including psychodynamic tools, to help with suffering. The broader and deeper our toolbox the more likely we can help those in need and so I welcome these additions to our armamentarium.

 

 

Posted in Musings | 2 Comments »

Mental Illness vs. Mental Suffering

Posted by Dr. Vollmer on July 29, 2019

 

 

The human condition means that sadness, fear, depression, excitement, enthusiasm, low activity levels and high activity levels are all experiences we cycle through to a greater or lesser extent. Oftentimes, in an effort to help others, providers over-diagnose these mental states by telling the patient that he/she has a mental illness, when in fact, he/she is suffering. Why is this distinction so critical? Mental illness implies psychopathology, that something is terribly wrong with that person. Mental suffering implies a hard time, something we can all relate to. To include others in a shared humanity is the job of providers to help patients in need. To separate out patients with a diagnosis should be done cautiously and rarely, as mental illness, is indeed rare. However with the DSM 5 hitting our trails, and the abundance of medications available to help mental suffering, there has been an explosion of both diagnosis and treatment which I believe has distracted patients and their families from understanding the deep roots of mental awareness. I think we can help those with mental suffering without diagnosing them with a mental illness. I know insurance companies make this hard, but we, as providers, must push back and tell patients that our medications (and now our machines) can help mental suffering, but this by no means implies a mental illness. Putting the locus on the common humanity along with its shared ups and downs, allows us to provide compassion, while still having the goal of minimizing psychic pain. And so I begin to make this point. More to follow. Thanks for reading.

Posted in Musings | 2 Comments »

Checking In…

Posted by Dr. Vollmer on July 24, 2019

Hello Dear Readers,
I am checking in to see about suggestions for future blog topics.

I also want to mention that I have traveled the country giving talks about the evolution of psychiatry and one participant said “I am going to remember that you said there was a difference between mental suffering and mental illness.” I repeat that now in all of my lectures. We, as psychiatrists, have over-diagnosed children and adults with mental illness, thereby causing people to externalize rather than internalize their issues. They seek quick fixes as opposed to deep introspection and reflection. Our medications and our new neuromodulation devices have encouraged people to look for the next “fix” and although I think our tools are very helpful, I also think there is tremendous value in psychological growth and development.

I consider myself an ambassador for the “old school” of psychiatry where symptoms were put in historical context, while at the same time, being schooled in the new world of psychiatry which now includes Ketamine, intranasal, and machines including TMS, trans-cranial magnetic stimulation, and TNS-trigeminal nerve stimulation, and Cervella-a headset which is FDA approved for depression, insomnia and anxiety. Come hear me at Pri-Med, or come talk to me on my blog. Cheers!

Posted in Musings | 4 Comments »

Goin’ On The Road

Posted by Dr. Vollmer on June 4, 2018

http://www.pri-med.com/medical-conferences/2018/regional-conference-chicago/agenda/sessions/QMONYA0EDUEF.aspx#sm.0001dcru4j43kf0pyjx2qs3r1e3hx

 

Regional Conference Chicago

Chicago, IL | June 7-8, 2018

McCormick Place–West

The Worried Well: Anxiety Disorders in Primary Care

Description

This talk will cover the assessment and treatment of anxiety disorders in a primary care setting, while incorporating new diagnostic issues incorporated in the DSM5. Signs and symptoms of generalized anxiety, panic and social anxiety disorders will be discussed, along with risk factors and available therapy options.

Learning Objectives

Classify anxiety disorders according to DSM5 guidelines

Choose a psychopharmacological agent to treat anxiety disorders

Manage patient anxiety in a busy clinical practice

Apply strategies to take patients off anti-anxiety medication


Speakers

Shirah Vollmer, MD

Shirah Vollmer, MD is a Clinical Professor of Psychiatry at the David Geffen UCLA School of Medicine. She is a board certified child and adult psychiatrist and she is a psychoanalyst. . Dr. Vollmer is a child, adolescent and adult psychiatrist and psychoanalyst in private practice in Westwood Village, California.

 

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Critical Thinking: A Therapeutic Goal

Posted by Dr. Vollmer on February 26, 2018

 

 

 

Critical thinking — what the philosopher John Dewey called the ability “to maintain the state of doubt and to carry on systematic and protracted inquiry,” is the goal of reflection. To modify Dr. Dewey’s quote, psychotherapy/psychoanalysis aims to help the patient develop critical thinking about one’s own mind and about the minds of those that influenced them. “I am not interested in symptoms” I say, in a provocative manner, to my class, knowing that saying that contradicts all of their previous education in psychotherapy. “I am also not interested in symptom-relief,” I say, taking it one step further. “What I am interested in,” I say, “is how the patient is thinking about his life and why those symptoms are manifesting at the particular time, and in the particular way, in which they do. ”

Karen, sixty-two, comes to mind. She has what could be called Generalized Anxiety Disorder, and I prescribe her medication, so in that sense, I am interested in symptom-relief, but mostly I am curious why she has to worry. I am helping her be curious as to why her mind is preoccupied with worry. The key words are “has to”. As I understand anxiety, it is often a symptom of a deeper issue of insecurity and loneliness  and I would like to explore that with her. I want to explore that with her in a way that makes her curious about it in a way which generates a  “systematic and protracted inquiry” and which carries on both inside and outside my office. This is what I do, and this is what I teach. Sure, I tell patients with anxiety to try yoga, meditation, and dietary interventions, but that is merely the beginning, because as time progresses, the issue becomes, “so what is really go on here?” To that question, there are endless answers, requiring a “systematic and protracted inquiry.” Dr. Dewey, may he rest in peace, is my hero.

Posted in Anxiety Disorders, Teaching, Teaching Psychoanalysis, Unconscious Living, understanding | 4 Comments »

Gender Health?

Posted by Dr. Vollmer on January 11, 2018

https://www.uclahealth.org/med-peds-care/gender-health-program

 

Image result for ucla gender health program

 

With deep respect for UCLA as an institution, and with deep respect for my training which has entirely occurred at UCLA, and with deep respect for the many departments within UCLA that I have been affiliated, I am quite curious and, dare I say, skeptical, about a “gender health program”. Reflecting back on my training in the 1980s (yea, I am getting old, I know), UCLA was doing transgender surgery, mostly in the department of urology. Mostly they were turning male genitalia into female genitalia. Other tertiary care medical centers were doing this too, and so this was a “standard of care” a phrase which has now been replaced by “evidenced-based medicine”. In the early 90s they stopped doing this surgery and so patients seeking a change in genitalia sought private practice doctors, both here in LA and around the world. Medical tourism was a popular notion among male-female transgender folks as they could pay out of pocket a fraction of the cost in another country, and that would include their airfare, a fancy hotel, and an American trained physician working in another country (usually their birth country). Somewhere around 2010, the “medicalization” of transgender patients took off, with the example being in LA, that children’s hospital started a clinic…

http://www.chla.org/the-center-transyouth-health-and-development and then pediatricians throughout LA, when faced with a patient who expressed discomfort with their gender, would be sent to Children’s Hospital. The assumption is that CHLA is a good hospital and so, therefore, they must appropriately deal with transgender issues, since most pediatricians have no training in this area. Somehow, UCLA seems to want to join the party, and so the Gender Health Program is born. I say this, with the complete disclosure that I am not aware of the politics, or the motivation behind opening this clinic, but I do enjoy speculating publicly (to my 50 or so readers), as to how transgender issues seem to come and go within the medical profession. Having Gender Dysphoria..as opposed to Gender Identity Disorder (GID)..see below

 

GID was reclassified to gender dysphoria by the DSM5. … The American Psychiatric Association, publisher of the DSM5, states that “gender nonconformity is not in itself a mental disorder. The critical element ofgender dysphoria is the presence of clinically significant distress associated with the condition.

 

…is a mental disorder. I am not sure that I agree that those who have distress over their gender are mentally ill. Sure, they need a prescription for hormones, and possibly surgery, to change their gender, so they do need medical care, but whether they need mental health care has more to do with individual preference. A patient, for example, might have extreme distress over the size of their nose, but they don’t need to see a psychiatrist if they opt for rhinoplasty to attempt to minimize their distress. I know this statement is very controversial when it comes to gender, but I think this argument is worth consideration. If the patient is curious as to why their nose distresses them so much, then mental health intervention makes sense, but if there is no curiosity, then mental health care is harder to execute. In the 70s being gay meant you had a mental illness. That quickly got fixed when psychiatrists realized the absurdity of that notion. Being bisexual, or uncertain of your sexuality, is also not a mental illness. So, I would say that being uncertain about your gender is not a diagnosis, but only a nodal point, which suggests thinking about how to proceed. As with all big decisions, we, as psychiatrists, can help people through them, but it is also true that people make big decisions without our help and do just fine.

Returning to the Gender Health Program, I can see the advantage of pooling patient populations in order to develop an expertise. I can also see the marketing advantage that the program makes people feel like they will have a place of understanding. My issue is that Gender Health is a made-up term. I wish they would call it a Gender Program. I am not sure what Health has to do with it, as the patient may not be sick to begin with.

 

 

Posted in Gender | 4 Comments »

Patient Sculpting

Posted by Dr. Vollmer on December 19, 2017

Image result for patient sculpting psychological

 

Hans Loewald  discusses the idea of patient sculpting, meaning that the therapist imagines the patient without his neurosis, and in so doing, imagines the patient having a more fulfilling life. What would the patient be like if he did not live out the guilt of his parents, for example. Lewis, sixty-six comes to mind. He is the son of holocaust survivors. Parents who instilled in him a sense that the world is a frightening place and he must be suspicious at all times. Lewis has embraced this philosophy unwittingly, living his life in constant fear, but not exactly understanding what he is afraid of. Imagining Lewis without anxiety is what some theoreticians call an “analytic stance”. If Lewis could come to understand that he “inherited” this fear from the trauma his parents experienced, then he could begin to separate out his reality from theirs. In so doing, Lewis could come to experience life in a more relaxed and engaging manner. Moreover, his physical symptoms of irritable bowel and intermittent headaches might improve substantially. A patient without anxiety uncovers the goodness of his soul, as anxiety can obscure that. Keeping the vision provides hope for patients. All of this is not spoken, and yet, magically transmitted between therapist and patient. How to teach these concepts is challenging and yet also very fulfilling. As with sculpture, each student has to find his method. The art of psychotherapy lies in its creativity and in its uniqueness with each therapist/patient dyad. There, I have said it again.

 

https://en.wikipedia.org/wiki/Hans_Loewald

Posted in Psychoanalysis, Psychotherapy, Teaching, Teaching Psychoanalysis | 4 Comments »

Is Psychiatry As Bad Off As I Say It Is?

Posted by Dr. Vollmer on March 6, 2017

Image result for psychiatry

Check out Kelly Brogan MD…http://kellybroganmd.com/, a psychiatrist, similar to my thinking, advocates for mental health without medication. Now, I do not completely agree that medications are hurting patients, although sometimes that is true, but I do agree that we as psychiatrists have gotten trigger happy, which means we are too eager to prescribe, and too reluctant to listen and put symptoms in context. I have recently taught second-year psychiatry residents (UCLA-15 total), psychodynamic psychotherapy students (New Center for Psychoanalysis-9 total) and I am about to teach primary care doctors .https://www.cme.ucla.edu/courses/event-description?registration_id=146702 about the diagnosis and treatment of anxiety disorders.  In each of these very different audiences I lament the loss of history taking in psychiatry, associated with the rush to prescribe and the consequences being unrealistic expectations and poor understanding of one’s personal dynamics. Associated with this are tremendous health care disparities in psychiatry where those without means are given care which is significantly lower quality than care given to those with discretionary income. Further associated with this are training programs where students learn to read checklists as opposed to asking and listening to open-ended questions. The patient’s narrative is lost and with that comes the loss of the excitement and joy of self-discovery; this loss being for both patient and provider. Burn-out seems like an inevitable consequence of our new model of care, but it will take many years to document this and so we must wait for evidence to validate our suspicions. Meanwhile patient care is suffering, and those with means can seek out care that makes sense, while those dependent on public funds are left to focus on symptom relief and not bigger picture understanding of what is killing their vitality. “I make students depressed” I say frequently, always to laughter, which goes with the grain of truth this gloomy picture represents. Exposing the problem remains the first step. Hence, I will repeat myself until this broken system starts to mend.

Posted in Psychiatry in Transition, Psychoanalysis, Psychotherapy, Teaching, Teaching Psychoanalysis | 2 Comments »

 
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