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 psychoanalysts toward the use of medication in psychoanalysis, yet few detailed case studies have appeared in which the effects of the introduction of a medication on the psychoanalytic process have been studied. A plea for fluoxetine (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 reenactment of crucial childhood experiences. The most significant change in the psychoanalytic process was a newfound ability to experience critical thoughts and feelings, which previously had been prohibited by her harsh superego. At first both patient and analyst believed that the medication had "softened" 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.