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Kelly, K.V. (1998). Principles, Pragmatics, and Parameters in Clinical Analysis: The Dilemma of Pharmacotherapy. Psychoanal. Inq., 18(5):716-729.

(1998). Psychoanalytic Inquiry, 18(5):716-729

Principles, Pragmatics, and Parameters in Clinical Analysis: The Dilemma of Pharmacotherapy

Kevin V Kelly, M.D.

Despite Freud's love of theory and his ambition to create a general psychology, he saw clinical analysis as a supremely practical endeavor, governed more by pragmatic considerations than by abstract principles. He hoped that subsequent generations of analysts would follow him in this direction and that it would lead to the inclusion of pharmacologic interventions alongside psychological ones: “We may look forward to a day when paths of knowledge and, let us hope, influence will be opened up, leading from organized biology and chemistry to the field of neurotic phenomena” (Freud, S., 1926p. 231). However, the difficulties of conducting analysis in the setting of sometimes massive resistance, regression, and transferencecountertransference dynamics have often led analysts to rely on rigid principles, rather than pragmatic decisions, as the foundation of clinical analysis (Michel, 1995). For several decades, one such unwavering principle was the belief that an analytic process would be compromised, if not destroyed, by the analysand's use of prescribed psychotropic medication. The most common argument in support of this principle held that the analysand's distress provided the necessary energy to motivate participation in analysis. Therefore, it was believed, symptoms should be relieved pharmacologically only when their severity threatened to disrupt the analytic process and could not be managed otherwise.

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