Psychoanalysis and Psychotropic Medication

A number of papers in this issue raise the question of whether we can integrate the findings of other disciplines into psychoanalytic theory and treatment, and, if so, how we can do so most profitably. Such an effort forces us to clarify the contributions unique to psychoanalysis and to consider which aspects of psychoanalysis may serve functions similar to those of such nonanalytic treatments as cognitive restructuring. These papers remind us that patients with certain diagnoses are not automatically to be ceded to nonanalysts.

Several possible research studies might be constructed to meet the challenges raised in the panel on panic disorder. Such research affords us the opportunity to integrate knowledge from other disciplines into our work and into our metapsychology. However, we must not be defensive or reactive in designing such studies. We need not abjure our own technical paradigms and modes of assessment—they are in fact essential to the proper study of analytic work. One group particularly worthy of study is patients with panic disorder who do not respond to medication or behavioral/cognitive therapy.

These papers raise important questions within analysis about the costs and benefits of combining modalities. Adequate consideration of these questions must start, as do Roose and Stern, by delineating our current practice. They report that roughly a third of training cases at the Columbia Psychoanalytic Center receive medication during the analysis. Is this true of other (or even most) institutes? How often are other nonanalytic modalities used to effect symptomatic relief in analysands, either on our own recommendation or by other practitioners (e.g., internists, chiropractors, wellness and stress-relief programs)?

Understanding the etiology and treatment of panic disorder, obsessive-compulsive disorder, and depression requires an understanding of the complex interplay between mind and