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Shirah Vollmer, MD
Shirah Vollmer MD

The Nature of Excitement

Overcoming fear is pretty exciting.

Fear is excitement without breath.
Robert Heller

Yesterday, I saw an old friend and she asked me what's new? With great enthusiasm I told her "I started a blog". Immediately, she asked "can your patients read it?" I said, "absolutely and you should watch what you say since your words may show up tomorrow". She laughed. I liked that she thought I was funny.

The fear and excitement of this blog feels like the beginning of a new relationship. I am excited about entering into new territory. I am scared that I could be too vulnerable. I am also scared that I could hurt someone. This converegence of hopes and fears yields a palpable excitement within me. It makes me wonder how excitement happens.

Is excitement the mastery of fear? In the case of this blog, that would make sense. I have wanted to express myself in writing, but I have stopped myself because I was scared that I would sound stupid, and because I was scared that I would say something which might upset someone. Eventually, I decided that I have ideas which I wanted to share so I needed to take the leap. I needed to see what would happen. I needed to try.

Excitation is related to the firing of neurons in my brain. When my brain feels positively activated three things are happening. My amygdala is being triggered, dopamine is being released and frontal lobe activity is being stimulated. The neurobiology of excitement does not help me convey the feelings to others. It does not help me unravel the complexity of the feelings which I experience.

Today, at a psychiatry lecture, I learned that stress is the inability to maintain homeostasis. My excitement about my blog challenges my homeostasis. I am in a state of hyperarousal. I suppose the neurobiologists are not distinguishing the different valences of stress. I have trouble with that.

Freud would say that all excitement is sexual. I disagree with Freud. Although there are similarities to sexual excitement, my experience of blogging touches upon the thrill of novelty, the movement from paralysis to productivity and from isolation to exposure. Freud does not describe these sensations.

So, once again I feel caught between looking to neurobiology to explain my feeling state and finding that the anatomy and physiology do not help me to describe this sense of excitement. By the same token the Freudian point of view leaves me feeling that this theory does not capture the complexity of my feeling state.

I am left with an opportunity. The door is open for me to describe the nature of excitement. I see the potential for a paper. I see an avenue where I could contribute to the literature. I feel excited about thinking about excitement.

I want to tell my friend that not only will my patients read it, they may even gain from it in ways that add to their experience of psychotherapy. I fear that if I say that, then my grandiosity will appear to have hypertrophied. At the same time, I hope that that this grandiosity will propel me forward. Today, the hope wins over the fear and my excitement continues.

About the Author
Shirah Vollmer, MD

Shirah Vollmer, MD, is an Associate Clinical Professor of Family Medicine and Psychiatry at the David Geffen School of Medicine at UCLA.

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