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The major points of this article are as follows: (1) To facilitate the use of medication in combination with psychoanalytic treatment, psychoanalysts needed to adopt a phenomenological diagnostic system as well as a dynamic model of the mind. However, psychoanalytic metapsychology precludes this coexistence, so analysts still often make medication decisions based on dynamic constructs rather than the relevant data. (2) Even when a phenomenological diagnostic system coexists with a dynamic model of the mind as a separate, but equally valid, construct, this coexistence has led to a mind/body split that is manifest in the fantasies of patients. (3) Phenomenology and dynamics cannot be integrated. They are different languages, using different data, and directed at different goals. Rather than integrate these two systems, they need to operate concurrently so that the patient does not dichotomize into “my depression or my character.” Instead, both dynamics and phenomenology are equally valid, although not always equally relevant, points of view.
Though once considered antithetical to psychoanalysis, medication is now commonly combined with dynamic therapies. This has become possible because it would appear that psychoanalysts permit two frames of reference to coexist—a phenomenological diagnostic