USTENTNG TO PROZAC, WITH THE THTRD EAR: A PSYCHOANATYTIC THEORY OF PSYCHOPHARMACOTOGY

Abstract: A model of the mind, utilizing constructs from object relations theory, is developed that bridges the conceptual gap between brain functions, influ-enced by the chemical milieu interior, and the psychodynamic construction of states of mind. A theory of self-regulation and regulation of the self is derived from the archaic mutual psychophysiological regulation between infant and mother that permits the actualization of a metapsychological structure, the in-ternalized "environmental " mother that interpenetrates with chemically alter-able brain physiology. This structure forms the background mental matrix of all experience and is maintained/altered either by meaningful (selfobject) relation-ships or by chemical agents and/or self initiated behavior, which modify the psychophysiological matrix directly via physiology. Linking this construct with a theory of internal object relations derived from Kernberg, and, a body of re-search documenting state-dependent learning, a clinically applicable theory of the direct (not symbolic) effect of physical events on the construction of experience is realized. The future may teach us how to exercise a direct influence, by means of par-ticular chemical substances, upon the... apparatus of the mind. lt may be there are other still undreamt-of possibilities of therapy.-Sigmund Freud, Out I ine of P sy choanal y sis,l 9 40 Why have so many psychoanalysts become enamored with the recent strides in neurobiology but have virtually ignored what could arguably be the most pressing mind-body problem facing psychoanalysis today, that is, to psychoanalytically describe how clrugs and other physical agents so radically alter subjective experience and presumably, the un-derlying psychodynamics? My hyperbolic assertion is supported by a survey of 277 analysts, published in 1995. Of 277 training analysts who responded, 20%had prescribed psychotropic drugs to their analytic pa-tients (Roose & Stern, 1995). No doubt this number would be higher to