Author's Response

Dr. Frosch has provided a framework to organize my response, and I want to use the comments of all six of the discussants in each of Dr. Frosch's three areas to clarify what I said in the paper and to expand it where necessary.

(I) The first category is “the meaning of drugs and drug use to this patient,” and each of the discussants directed attention to the ego processes that form the central thesis of the paper. Following Giovacchini's1 description of the varieties of scientific critique will facilitate my response to the discussants. Dr. Frosch credits me with having formulated the meaning of marijuana and of LSD in terms of pleasure and of painful threat to be mastered. These were, however, the patient's descriptions; they are data rather than my formulations. Dr. Ostow does not find it useful to regard hallucinogenic drugs as defending a patient against disruptive introjects. I do not want to repeat here the clinical evidence for this view, but rather will try to comment on the ego boundaries mentioned by Drs. Doi, Frosch, Limentani and Ostow, and indirectly by Drs. Blacher and Esman, as well as on the “stimulus barrier” mentioned by Dr. Ostow.

The patient was simultaneously secretive and withdrawn from me,

and merged with me. The withdrawal was because she feared that I would have a destructive influence in her life, and in the merged state she became a “bad psychotherapist,” saying that she had a destructive influence in the lives of others. She also wanted to see me as a saviour, and wanted me to have used drugs in order to be able to understand her. This represented part of the merging, and when she felt that she was “being me,” she felt trapped with me: I was a part of her and she could not leave me without losing a part of herself. This certainly contributed to what Dr. Esman described so graphically as “the agony of a young woman driven