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Over the last fifty years the availability of medication for the treatment of psychiatric disorders has created challenges to the theoretical framework, identity, and mode of practice of psychoanalysts (Busch 1998; Roose and Johannet 1998). During this time analysts have in general shifted from dismissal of the value of medication to viewing it as a useful adjunct to psychoanalytic treatments (Roose 1995). Purcell argues that the pendulum has now swung to an assumption of synergy and an overreliance on objective criteria that separate medication use from psychoanalytic work. He usefully warns that this attitude can lead to problematic enactments involving narcissistic and perverse resistances that disrupt the integrative efforts of an analysis.
While alerting us to a potential scotoma in our current view of psychopharmacological interventions, Purcell evinces a series of antimedication biases. Although claiming that “there are often clear medical, ethical, and legal rationales for the use of medication either as the primary treatment or as an adjunctive modality” (pp. 913–914), it is difficult to determine under what circumstances he would consider medication to be indicated in a psychoanalytic treatment. He views medication primarily as antiintegrative and disruptive of the goals of psychoanalysis. We will discuss how Purcell's stance can itself lead to problematic transference-countertransference enactments. Thus, his effort to correct the problems of presumed synergy contains important remnants of an antimedication bias that subvert his primary goals, to foster an optimal analytic attitude and process.