Psychoanalysis in conjunction with medication: a clinical research opportunity

The increasingly common practice of introducing medication into the analytic relationship is of practical and theoretical concern to analysts. Pharmacological agents and their somatic effects, it is argued, may be seen as a research equivalent to brain lesions, long favored tools in correlating brain with mind function, while psychoanalytic process data may be seen as a fine-tuned instrument for studying the subjective and emotional processes that reflect the underlying brain effect. A method of naturalistic study of psychoanalytic process both with and without a psychopharmacological agent is described and illustrated in two patients. The potential of this method for providing data useful in understanding the mechanism of action of psychoactive medications and of individual variations in response is explored. Both patients, treated with stimulant for ADHD, showed striking differences in self- and object representation, defense, affect, and cognition that correlated with analytic periods on and off the medication. The implications of these observations for understanding both the action of the medication and the fundamental functional disruptions in the condition are explored as well.