4inquiries (4inquiries) wrote in psychoanalysts,

PRDF on Drug Therapy and ECT

From The Psychodynamic Approach to Drug Therapy (1979):

Ostow, with a number of analysts working under the Psychoanalytic Research and Development Fund, presents research on the problems of drug therapy as well as the relationship of electric shock therapy to drug therapy. “Psychoanalysts can no longer afford to ignore organic treatment modalities, especially drug therapy,” because the “efficacy of drug therapy cannot be questioned” (1). Anti-psychotic medication can allow a patient to enter analysis that was otherwise inaccessible, and analytic therapy can stabilize the patient enough to remove dependency on drugs.

Problems with drug therapy include patients’ highly variable sensitivities to different drugs. Drugs often have an effect on both ego function and ego libido, such as an anti-psychotic sedative, which increases difficulty for diagnosing patients on the basis of a given drug reaction. Some therapeutic drugs have “toxic effects” like “seizures,” but it is not clear whether such effects are organic or psychodynamic (20). Some patients will not want to take medication because of psychodynamic reasons, perhaps even hoarding medicine as a gift from the analyst. And the “least educated” people are “negligent about taking medication,” and some patients take too many doses at once (10). “If the patient experiences side effects, he may resist the drug and fail to improve as he should,” so warn the patient of side-effects (51). One screw up with a patient’s medication can deteriorate the patient’s trust in the analyst and future drug therapy. Successful use of medicine may initiate a rescue fantasy in the patient’s transference, which is “the wish to be made pregnant by the analyst through the medium of the pill” (61). “Even when the patient on medication is capable of taking an interpretation seriously, it may have little value in modifying his behavior” (55). Roost claims that “the analyst loses control of the transference” when the patient is medicated (56). Roose argues that “it is the state of the transference that determines the response to side effects” (62).

The PRDF group considers the relationship of electric shock therapy to drug therapy and psychoanalytic therapy because electric shock therapy “was employed in the management of some of the cases that were studied” (7). For patients who show improvement on anti-depression drugs, “stress may cause relapse,” which indicates need for dosage increase or “the addition of another form of treatment such as electric shock treatment” (6). Actually, “electric shock treatment compromises the analysis” if the analysis is already underway, but the “procedure may make a patient accessible to analysis who otherwise would not be” (58-59). Dr. Louis Linn argues that “a brief intensive series of shock treatments is perhaps more rapidly effective in the termination of an agitated psychotic state than drug therapy” (22). Feder argues that “electric shock treatment is considerably less destructive than he used to think it was,” and Linn reports “two cases of agitated depression which had been resolved by electric shock treatment” (59). With Linn’s agreement, Ostow theorizes that “electric shock therapy might be effective because it induces amnesia” of “the pathogenic stressful situation,” though this is only the case for ECT patients who experience post-shock ‘confusion’ (22). Again Ostow argues that “electric shock treatment... facilitates denial,” “Following electric shock treatment, the denial and the relief from depression will persist until the patient is once again overwhelmed by reality” (42). Electric shock therapy and psychosis operate on a common “withdrawing from object relations” which “cannot be tolerated indefinitely because in turn it induces shame, anxiety and feelings of numbness, deadness and emptiness” (42). ECT is less likely than drugs to make a psychotic reflect on previous psychotic material. Linn, pointing out the problem of side effects with drugs, notes that “electric shock treatment can be given in a way which is minimally disruptive” (59).
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