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December 8, 2002. Richard Gottlieb's stimulating discussion of the effects of SSRIs, in which he argues that the demonstrable efficacy of these medications in such seemingly unrelated disorders as depression, social anxiety, and obsessive-compulsive disorder is explainable by the proposition that “the essential benefits of these medications derive from their capacity to modify aggression,” is an unfortunately all-too-rare instance of the way that psychoanalytic thinking “out of the box” can productively be applied to other disciplines, and to matters that transcend analysts' doctrinal arguments and specialized clinical tasks. His line of thought, if extended by the sorts of research that he suggests, gives hope that, someday, psychiatric diagnosis may move beyond sterile catalogues of behavior that are clinically valueless, and often shackling to our students, toward a classification that reflects essential commonalities and processes in the mind.
Gottlieb's use of analytic thinking away from the couch has much in common, in principle, with the great research applications of psychoanalytic ideas that were once such an impressive part of academic psychology and anthropology—as by Adorno, Bruner, Erdelyi, and others—and that practitioners in various medical disciplines once found so useful in understanding psychosomatic interactions. It is a refreshing sign that we're not dead yet, still relevant, and I think he deserves thanks from all of us for that.
There is a next step that might now be taken—which is to ask more about the modification of aggression brought about by SSRIs. What is the mechanism of their action? Do they directly affect aggression on a CNS level? Could there be an indirect effect, as on the motor channels that express aggression? After all, in most of the syndromes that he cites, and in most of those that we encounter in daily practice, the pathogenic conflict centers on the patient's fear of his or her aggression, the sense of being potentially dange