Drug Therapy and Modern Psychoanalysis

Historically there have been two distinct streams in thought and investigation about emotional disorders: the physiological and the psychological. Freud, who began as a neurologist, was well acquainted with both, and even suggested that his psychological approach might give way to later physiological knowledge:

Here we are concerned with therapy only in so far as it works by psychological means, and for the time being we have no other. The future may teach us to exercise a direct influence, by means of particular chemical substances, on the amounts of energy and their distribution in the neural apparatus. (1938, p. 182)

Investigations in the two fields are conducted with different methods and usually by different people. As in the proverbial case of the blind men and the elephant, a person with an emotional disorder may receive quite different diagnoses and treatments depending on the orientation of the treating therapist.

In recent years, the most productive physiological line of endeavor has been in the field of psychopharmacology, the treatment of emotional disorders with drugs. These drugs have in part fulfilled Freud's prediction: they do alter levels of energy by influencing neurotransmitters in the brain. Through such treatment, hundreds of thousands of patients have been released from state mental hospitals and have been enabled to lead productive lives. However,