The effects of the introduction of medication on the psychoanalytic process: A case study

The past fifteen years have seen a marked change in the attitude of psychoa nalysts toward the use of medication in psychoanalysis, yet few detailed ca se studies have appeared in which the effects of the introduction of a medi cation on the psychoanalytic process have been studied. A plea for fluoxeti ne (Prozac) as a weight-loss aid, from a female patient whose analysis had progressed satisfactorily, set in motion a remarkable series of events. Her mood brightened, she rapidly lost weight, and she ultimately realized that she had the fantasy of being impregnated, all of which represented the ree nactment of crucial childhood experiences. The most significant change in t he psychoanalytic process was a newfound ability to experience critical tho ughts and feelings, which previously had been prohibited by her harsh super ego. At first both patient and analyst believed that the medication had "so ftened" her superego, but reexamination of the data revealed that most, if not all, of the changes could be attributed to the transference meaning of the collaboration rather than to the effects of the drug.