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“Should drugs be used in psychoanalysis and psychotherapy?” Dr. Ostow opens his extremely interesting book with this question and proceeds to answer it immediately. His answer is “yes.” But he also sets down clearly defined instances where drugs should and should not be used. No drug can do what analysis does, he hastens to assure us, but a drug can
“undo the ego distortion and disruption which are responsible for the florid symptoms of an acute neurotic or psychotic crisis.” Dr. Ostow feels that drugs can reconstitute a fragmented ego, making psychoanalysis possible for patients otherwise too ill to participate in it. He also feels they can diminish suicidal danger, tide a patient through an occasional acute exacerbation of illness during analysis, thus avoiding hospitalization, and protect a patient who becomes disturbed in his analyst's absence. He believes drugs will someday be of value in facilitating the “indolent analysis.” He does not feel there is justification for the administration of drugs “in the ordinary analysis of patients whose self-control, reality testing and capacity for detached self-observation are sufficient to permit the psychoanalytic process and to meet the minimal requirements of daily living.”
Dr. Ostow draws his conclusions from his clinical experience with 13 analytic and 5 non-analytic patients over the six year period since drugs have become important to psychiatry. He mentions also, a “control group” of 33 drug patients seen briefly at infrequent intervals over the same time span.
The monograph is divided into several sections. One chapter on “Psychic energy, psychic function and the drugs,” attempts to correlate Dr. Ostow's psychoanalytic concepts with drug action and neuro-physiologic activity. This attempt appears to me to be the weak link in the book. Dr. Ostow's analytic framework is orthodox Freudian and includes the death instinct, a concept which many other analysts have found difficult or impossible to maintain. In attemptin