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Roth, N. (1990). Does Neurology Inform Psychoanalysis? A Case Report. J. Amer. Acad. Psychoanal., 18(3):512-518.

(1990). Journal of American Academy of Psychoanalysis, 18(3):512-518

Does Neurology Inform Psychoanalysis? A Case Report

Nathan Roth, M.D.

The purpose of this communication is to emphasize a consequence for psychiatry and psychoanalysis that has accompanied the “remedicalization” of psychiatry. The psychoanalyst today has to learn more than the administration of psychotropic drugs, a practice that is now recognized as not interfering with the psychoanalytic process and is often absolutely necessary for a patient both to tolerate the severity of his or her symptoms and to negotiate the tedious journey of a lengthy analysis. There is now an additional requirement that emphasizes the stringent necessity of making a correct diagnosis in cases that were formerly merely turned away by the psychoanalyst, avoiding confrontation with a problem that today demands attention.

Many psychiatrists and analysts claim that there is no such condition as conversion hysteria and that any sign or symptom that is diagnosed as a conversion manifestation has been seen in organic diseases of the nervous system (Slater, 1965). Several disorders are often erroneously diagnosed as conversion hysteria when they are actually organic diseases of the nervous system and pose the risk of a malpractice suit for the unwary psychoanalyst. The recent climate of malpractice suits has led to the appearance of such journals as Investigative Reporting. The disorder I shall discuss today can be seen to have resulted in all the misery of such suits in that journal, for this is a condition in which a faulty diagnosis causes both the patient and the practitioner much grief.

The patient under scrutiny here came to me in 1970 at the age of 23. She had first seen a prominent child psychiatrist at the age of 13, and he had then turned her over to a female psychiatrist who treated her for the ensuing five years, with, according to the patient, little or no amelioration of the complaints, so that the patient finally terminated the treatment. It should be pointed out that the young lady in question was not the easiest person to treat in that her behavior did not endear her to a therapist.

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