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March 12, 1963. PATHOGENESIS, SYMPTOM FORMATION, AND ENERGETICS. Mortimer Ostow, M.D.
Dr. Ostow discusses the pathogenesis of mental illness from the economic point of view, using data from his daily observation of analysands whose symptomatology and mental states he controlled by the administration and withdrawal of two types of antipsychotic drugs, reciprocal in their action. The tranquilizers relieved some acute, excited attacks of schizophrenia and mania and, when given in excess, produced symptoms characteristic of melancholia, whereas the antidepressives, or 'psychic energizers' had a reverse effect, relieving melancholia but, when taken in excess, producing mania and schizophrenia. If, as according to Freud, melancholia reflects an ego libido impoverishment, while the excited states reflect a surfeit, then it may be postulated that the tranquilizers act by depleting the ego of its libido and the antidepressives or 'psychic energizers' by increasing it.
Dr. Ostow refers to his paper of 1962 describing the construction of an indicator of an ego libido supply based on nine clinically observable variables. Using pharmacological agents to control libido supply and this indicator to measure its level quantitatively, it becomes possible to make observations from which a theory of pathogenesis based on energetics can be developed.
The first theoretical conclusion is that ego-libido depletion is a normal homeostatic mechanism whose function is to correct actual or threatened flooding of the ego by libido; when the device overcorrects, a deficiency syndrome such as melancholia results. The homeostatic mechanism may be replicated by giving some patients a small amount of tranquilizer along with basic energizing supports. In such cases the patient, instead of passing from melancholia to mania or schizophrenia as he would ordinarily do with an energizer alone, actually remains within a channel of libido fluctuation not unlike that of the normal person.
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