Edward Nersessian, M.D.

The subject of giving medication to analytic patients is one that comes up with increasing frequency in informal discussions with colleagues across the country, and, in addition, has come to the attention of a larger audience as a result of the well-publicized Asheroff case and the attendant conflicting debate between Gerald Klerman and Alan Stone generated by that case. Stone voiced the concern that some of the expert witness testimony in this case could well lead to a situation wherein the threat of malpractice could be used to advance a point of view about what psychiatric treatment should be. Such worries appear to be justified, especially in legal suit-ridden states, where many psychoanalysts are said to prescribe medication to their analytic patients for fear of malpractice litigation.

No doubt we live in litigious times. We also live in economically difficult times, and analysts naturally are not immune to worries about their livelihood, either. This point was brought home to me recently by a colleague who, during a discussion about who should prescribe and monitor medication during analysis, bluntly said, “I don't send them to someone else because I may lose them.”

I do not mean to trivialize these factors; they are among the realistic considerations an analyst includes in a decision about the place of medication in any given analysis. At the same time, however, these are really what I would consider as falling under the rubric of “practice” issues.

Propitious as it may be from the vantage point of psychoanalysis as a “practice” to discuss the issue of using medication in analysis, it is premature to draw conclusions from such discussions. There has been no systematic attempt to study the use of medication during an analysis, and on the basis of a handful of clinical case reports such as we have heard tonight, no scientifically valid conclusions can be reached. Until more information is available, answers to the questions we are discussing tonight will remain a