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Each of the five papers in this section presents psychoanalytic case material in which psychotropic medications played a role. Consequently, this section gives the impression that the editors and authors have assumed as true an assertion that once was controversial: that psychoanalytic treatment is in fact compatible with the effects of mind-altering drugs and the medical management procedures that necessarily accompany their prescription. Yet not long ago a well-known and respected analyst of an earlier generation asked me, rhetorically, “How can you psychoanalyze someone who is asleep?” And, of course, by “asleep” he did not literally mean somnolent, but was referring hyperbolically to the effects of psychotropics.
Many matters in psychoanalysis that were once controversial have ceased to be so. Examples are abundant. We no longer automatically assume that prior psychotherapy necessarily rules out subsequent psychoanalysis by the same analyst; we no longer assume that psychoanalytic treatment of the chronically ill or the elderly is out of the question, as many analysts did in the past; and we no longer assume that the homosexualities are “illnesses” to be “cured” by psychoanalysis.
Certainly there is not unanimous agreement about the feasibility of combined treatment, but a powerful confluence of factors has developed over the past fifteen to twenty years that has contributed to what many consider a sea change in the attitudes of analysts toward this practice. The first of these was the widespread acceptance of a new generation of psychotropic agents heralded by the introduction of Prozac in 1986. Many of the new agents were safer to use and more specific in