This brings up one of the most important issues on which no general agreement has been reached. A certain number of patients receiving the drugs function adequately, lose their symptoms, feel comfortable, and for all practical purposes are able to live a normal life. This may often be within the framework of some limitations, but nevertheless conspicuous mental symptomatology is absent. It has not been established as yet how many patients are able to do that by receiving only the drug and without any psychotherapy. In the state hospital system, we see quite a number of patients who show improvement under these drugs and maintain their improvement after they are discharged even though they receive very little psychotherapy. In a considerable number of patients, psychotherapy is needed in addition to the drug treatment. This is especially true of patients who are improving and are becoming aware of some of their conflicts or adaptational difficulties with the environment and would like to have help in overcoming these difficulties.

A considerable number of patients become more amenable to psychotherapy while under the drug. Because the psychiatrist’s time is not absorbed by giving these patients reassurance, some of the adaptational difficulties and conflicts can be disclosed more rapidly and at times more incisively than otherwise. How psychotherapy should be applied to patients under the influence of the tranquilizing drugs is still under investigation. We are all groping in this field and no definite conclusions can be drawn. We do not know how far psychotherapy can be modified or applied over a much shorter period than has been customary in the past. Do the drugs support or replace certain psycho-therapeutic functions or not? It is also unclear how the psychotherapeutic techniques should be modified with patients under the influence of drugs. It is obvious that a patient who is not anxious, who is relaxed, and who is not constantly preoccupied with what is going on inside of himself is far better able to externalize interest and participate in group or in individual psychotherapy than otherwise. Even in optimum circumstances, psychotherapy with a psychotic individual is a very tedious, hard, and uncertain job. It is possible that with the help of the newer chemical compounds and perhaps even more with those still to be introduced, psychotherapy with these patients will become more effective and more economical of time.

Some psychiatrists have raised fears that many patients under the influence of these drugs will lose their anxiety. This is particularly true of some neurotic patients. In this event they would not have the motivation to undergo psychotherapy. It is possible that in some patients the drugs remove the discomfort and the patient will not seek any other psychiatric help. It is not yet clear if in those patients where the drugs are so successful that they are completely symptom free and functioning well, whether they really need further psychiatric treatment or not. This will have to be decided in each individual case.

Some psychiatrists also maintain that the extensive use of these drugs is deplorable because they deprive the patient of his incentive to undergo psychotherapeutic or analytic work which is the only treatment able to affect the patient’s emotional difficulties on a causal level. We would like to call attention to the fact that in present-day psychiatry there are only a few conditions where we are able to apply a causal treatment. Most of our treatments as used today, somatic or psychotherapeutic, are symptomatic. To be able to claim that psychotherapy does a causal etiological job in a psychotic individual would imply that we know the origin of these disorders. Based on present-day psychiatric knowledge, the etiology of quite a number of neurotic disorders is also obscure. Therefore, to assume that one treatment is symptomatic and another is causal is unwarranted.

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1. Drug Therapy in Psychiatry. Part 8 Observations obtained from carefully studied individual cases and from mass experiments would indicate that the tranquilizing drugs act by suppressing the patient’s symptomatology. They suppress certain clinical manifestations in the patient in the same way as an anti-epileptic drug suppresses epileptic discharges. From a...
2. Drug Therapy in Psychiatry. Part 4 The drugs, of course, are used not only in psychotic patients but in many neurotic patients. The tranquilizing drugs are prescribed in large quantities outside of mental hospitals and practically every physician today prescribes these drugs to patients when he assumes that some emotional...
3. Drug Therapy in Psychiatry. Part 3 At present we are using drugs in large numbers of patients. This does not necessarily mean that these patients should not have a physical and mental examination and that details of their psychiatric illness are not appraised. Mass use of the drugs should not...
4. Drug Therapy in Psychiatry. Part 2 Most of the reliable information on the action of these compounds relates to psychotic patients. A considerable literature also exists on then-use in neurotic patients. However, the interpretation of data with these patients is far less reliable than with psychotic patients. The oral use...
5. Drug Therapy in Psychiatry. Part 6 We feel the following trends in the use of the tranquilizing drugs should be checked. First, patients should not receive a tranquilizing drug without proper physical and mental examination. We know that some of the drugs can lead to physical complications and therefore the...