Charles Brenner, M.D.

Every day for four years of high school and later on for four years of medical school I passed by a building in whose stones the following words had been cut: Art is long, life is short, the need is urgent, the decision difficult, the dangers great. These are sentiments to which all engaged in clinical work subscribe, sentiments which form the basis for the excellent presentations we have had the privilege of hearing this evening.

What both audience and speakers are concerned with is how best to treat a certain group of analytic patients. They are patients whose analyses are long and difficult, sometimes to the point of stagnation, and who fall into the categories of chronic depressive illness and/or bipolar disease. They are sicker than usual patients with a more difficult than usual analytic course.

Now sicker than usual analytic patients whose analyses are slow and difficult, but who are not diagnosed as having some variety of what is meant by depressive illness are no rarity. We struggle along with them as best we can, sometimes with a good final result and sometimes with results that aren't so good. Sometimes we have to give up trying to analyze them altogether and recommend some other form of care, perhaps custodial in nature. But what we have heard tonight is that there is a group of sicker patients, of patients with long and difficult analyses, who can be analyzed because their symptoms respond favorably to certain classes of psychotropic drugs. The problem is, first, to make sure that a particular patient belongs to the group of sicker patients who will respond favorably and, second, to find the right medication and the right dose for that patient.

Both Dr. Cohen and Dr. Scharf have made it quite clear that this is not an easy problem to solve. We can only do our best, we can only weigh all the evidence as carefully as possible, we just do not know enough at the present time to be sure we will decide correctly. But, remembering the words of the ancient physici