Discussion from the Floor

I think it has been very important to have held this panel discussion. The files for the last thirty years of scientific meetings of The New York Psychoanalytic Society show that there never before has been a session devoted to this controversial subject. Yet it is a subject concerning which opinion has been plentiful. There are those who believe that the treatment that is truly psychoanalysis is not possible in conjunction with psychotropic medications. There are those like Drs. Scharf, Cohen, and Willick and others who believe that treatment that is in all its essential features psychoanalytic is possible with the concurrent use of medications, although the effects of the medication upon the treatment process need to be very carefully assessed. There are others, including myself and probably many others, who believe that the issue has not yet been decided, and that we are only now beginning to examine and to discuss the evidence in important forums, such as this one.

It is interesting that in the past among those who believe that analytic work was possible with psychotropic medications, most, it seems to me, favored the idea that the medications be prescribed and monitored by someone other than the analyst. This preference seems perhaps to have changed. Tonight we heard Dr. Cohen's cases, in which she undertook to manage her patient's medications. In Dr. Scharf's case too, medication was managed by the analyst himself. Dr. Willick has spoken with me of several cases of his own in which he has managed the medication and Dr. Auchincloss's case, presented last spring at the panel of the American Psychoanalytic Association, was one in which she prescribed and managed the medications herself. It could be added that in Drs. Cohen's, Scharf's, and Auchincloss's cases the medication management was quite complex, requiring considerable knowledge and skill with the agents used. We don't have a statistical sample here, but I suspect