You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
February 2, 2003. Richard Gottlieb supports the analyst's “unique form of listening” when working with patients taking psychotropic medications and correctly notes that “SSRIs challenge traditional diagnostic schemes.” What I do not understand, however, are the conclusions that he has reached as a result of his “listening.” His assumption that the effectiveness of SSRIs for such different conditions as OCD, social anxiety, and depression suggests a common mechanism—e.g., aggression—underlying these different pathologies is reductionistic and a throwback to highly disputable metapsychogical notions. Not only has the traditional drive formulation of aggression been of questionable value for clinical psychoanalysis, but it is even more dubious to apply such a concept to contemporary psychopharmacology.
I understand that Gottlieb emphasizes that his is a “psychoanalytic hypothesis; … not psychiatric, electrochemical, or neuroanatomical.” Yet, despite this disclaimer, his proposal must still support the clinical data. Furthermore, when he refers to the DSM diagnostic categories of Major Depression, Obsessive-Compulsive Disorder, and Social Anxiety Disorder, there is the implicit recognition of the importance of attunement to the syndromal nature of certain psychopathologies. Recognizing the ubiquity, consistency, and bottom-line, sine qua non nature of certain clinical presentations (i.e., as syndromes) challenges