Prologue

The last several years have seen a revolution in the use of psychopharmacological agents. The broader use of medication is owed in part to the “user friendly” quality of newer agents with reduced side effects and increased safety. In addition, a wider array of medication is available for treatments of bipolar disorder, depression, panic disorder, generalized anxiety, and psychosis. The popular press has aided in informing many people about symptoms of various psychiatric illnesses and the availability of medication. The possible use of medication must be at least considered for every patient who comes for consultation. Thus, from the initial consultation, medication becomes “another presence in the room”. If medication is used and, at times when it is not, it becomes an ongoing presence, in which its various impacts and its meanings must be assessed and integrated into the complex web of treatment.

In addition to these factors, medication has been found to treat a broader range of dysphoric affect states and disturbed cognitions than what was previously thought. Kocsis et al. (1988, 1996) demonstrated that dysthymic disorder or chronic depression frequently responded to medication. Dysthymic patients experience depressed moods, sometimes over many years, but do not have the degree of cognitive and vegetative symptoms that patients have with major depression. Kocsis et al. (1988) also noted that many patients had not responded to long-term psychotherapy. Dysphoric affect states and cognitive experiences of danger and futility that reach a certain level of intensity and persistence may be partially or fully relieved by medication. For example, medications can be helpful for paranoia that is not of delusional proportions or affective lability that does not meet diagnostic criteria for bipolar disorder.

In addition, some of the boundaries between what has been called character and what are biochemical “imbalances” that can be treated with medication are much le