Letter to the Editor

June 1, 1992

I want to write to express my thanks for the publication of your new journal. A forum for clinical reports in our field will fill a real need. Your initial issue focusing on the use of psychotropic medications in conjunction with psychoanalysis was especially useful for me as it arrived while I was preparing a final case report for my psychoanalytic training—and needed support for my contention that I had successfully dealt with the patient's use of an antidepressant medication during the analysis. Even in the interdisciplinary institute where I received my training, there was some discussion of whether the two treatment modalities could be combined.

However, I was dismayed a bit by the title of the Editor's Introduction—“Medications and Psychoanalysis, An Alloyed Analysis or Still Pure Gold.” I am concerned that an attitude persists that there is such a thing as “pure” analysis and that this “purity” should be kept “unalloyed.” It seems to me that we forget the purpose of psychoanalysis is not to create cases in which pure analytic technique has been demonstrated but to treat patients.

This attitude is, I think, exemplified in the case report provided by Maria T. Rodriguez-Boulan, M.D. (pp. 129-133). Dr. Rodriguez-Boulan describes her patient as suffering from “chronic feelings of depression, characterized by poor self-esteem, low energy, social isolation, and weight fluctuations of 20 to 30 pounds.” She also notes a family history consistent with affective disorders. However, when the patient (apparently in the first year of analysis) requests antidepressant medication, the analyst states that there were “no clinical signs of major depression.” This assertion is made despite the initial symptoms and new complaints of being “very depressed,” “lonely,” feeling “worthless, ugly, and unloved,” “socially more reclusive,” and having “no energy or desire to do anything at home.” I think most of my