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In the past two decades, much has happened in the relationship between psychoanalysis and psychophar-macology. Originally, the so-called pharmacological revolution in psychiatry that began in the late 1950s was seen as a direct challenge to psychoanalytic theory and practice. Trainees through the 1960s and 1970s were often faced with the demand to choose sides: psychopathology is either the result of unresolved unconscious conflict or abnormalities in the levels of neurotransmitters. The latter point of view even denigrated the importance of dreams. A prominent scientist at the time held that dreams represented responses to random changes in serotonergic neuronal firing and therefore carried no coherent meaning of use to the mental health professional.
Although, to be sure, there are some who still indulge in these dichotomies, they seem woefully old-fashioned nowadays. We no longer believe that the level of a particular neurotransmitter has much to do with an illness like depression or panic disorder. Rather, modern neuroscience has begun to show us that emotional regulation involves the coordinated function of brain circuits that involve multiple chemical messengers. Furthermore, the intensity of response of these circuits in any individual is dependent on inherited factors and experiential shaping. Freud said essentially the same thing on multiple occasions, beginning as early as the “Project” (1895). Neuroscientists today speak comfortably about the “unconscious,” although they are most likely to refer to it as “implicit” memory, and to acknowledge that early life experience has profound influence on the emotional nature and behavior of organisms for the rest of their lives.
Mortimer Ostow, in retrospect, seems to have known this all along. It is hard to think of a psychoanalyst who did more to champion the benefits of psy-chopharmacology. But most importantly, Ostow has done this without sacrificing his allegiance to the legitimacy of psychoanalytic theory. For h