Challenge Of Combining Paradigms

Contemporary psychoanalysis and biological psychiatry have traditionally had different goals. Biological psychiatry has focused on developing accurate nosology and effective medication treatments for relief of the symptoms of mental disorders; functional improvement is the goal and permanent psychic change is not expected. The goal of psychoanalysis is not mood and behavior change, but rather the uncovering of unconscious mental contents, leading to new self-understanding, psychological autonomy and mental freedom. Change in mood and behavior may result from these new capacities but is not the goal at the outset.

Thus the polarization of biological psychiatry and psychoanalysis is understandable, but it has ill served both patients and trainees in various mental health fields.

Biological psychiatry, abetted by the managed-care industry, has made possible "rela-tionshipless psychiatry" (Gardner, 2001) in which patients are "managed" by non-psychiatric (lower-cost) therapists and given prescriptions by psychiatrists who, at times, barely know them. Proponents of traditional psychoanalysis have maintained that mental states have a psychological background that, if analyzed, can lead to symptom remission but have largely failed to embrace the use of standard nosologic diagnosis, or to openly sanction the use of medication in alleviating symptoms. The combining of medication and psychotherapy by practitioners who understand both depth psychology and psychopharmacology represents a significant advance in the evolution of psychiatric practice. Since this approach falls between two very different paradigms, it calls for the willingness to adapt our psychoanalytic traditions and biological knowledge to the real needs of our patients.

Given the lack of controlled studies of psychoanalytic psychotherapies, (Gab-bard et al., 2002), this practice must proceed on the basis of well-informed clinical judgment rather than results of definitive multicenter trials. Therapeutic thinking that bridges traditional paradigms will be illustrated in this chapter with descriptions of psychoanalytic cases.

Anxiety and Depression 101

Anxiety and Depression 101

Everything you ever wanted to know about. We have been discussing depression and anxiety and how different information that is out on the market only seems to target one particular cure for these two common conditions that seem to walk hand in hand.

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