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Freud expected a time when drugs would be used during analysis to direct it into the most fruitful channels. Ostow explains his own use of drugs as an aid to psychotherapy or psychoanalysis of highly disturbed patients. The book is based on observation of thirteen patients in analysis and five in intensive psychotherapy. As a control he used thirty-three patients treated primarily by drugs. He gives a detailed account of treatment of a neurotic and a psychotic patient (both still in analysis at the time of writing) to demonstrate the use of drugs.
Ostow summarizes his recommendations thus: 'No drug should be given in the course of psychoanalysis or psychotherapy which is of the uncovering, insight-giving type, unless the treatment cannot proceed without it, or unless there is a serious threat to the patient which medication can alleviate. No drug can substitute for good psychotherapeutic technique, and drugs should not be invoked simply to overcome resistances which should properly be handled by interpretation. The correct administration and regulation of pharmaceutic agents is … complex and difficult… [But] when there is an acute need, and the right drug is given at the right time, its effect on both the patient and the therapy is striking.' Use of drugs may obviate shock treatment or hospitalization, which procedures are damaging to transference.
The study involves the application of the libido theory with emphasis on the variation of libidinal psychic energy arising within instinctual sources and driving the dynamic processes. To regulate the administration of drugs only libidinal energy was considered. Ego function varied with the amount of psychic energy available to it. In melancholia, for example, antidepressant drugs—'energizers'—increase the libido content of the ego. Tranquilizing drugs decrease the amount of instinctual energy available to the ego. Both types act upon the basal ganglia, which are concerned with the generation and distribution