The action of psychotropic medication by the change of internal object relations - the case study of initiation of separation processes and feeling of manhood in the 60-years old patient

Abstract

The paper presents the case of 60 years old male patient with agoraphobia, autodestructive impulses and some obsessive-compulsive features. Treatment with citalopram was initiated in this patient. In the course of treatment symptomatic improvement was observed. It was followed by improvement in the range of patient's activities. The patient interpreted it in his personal context as a process of becoming more virile. Two important processes started in his mind - becoming a "true" man and previously blocked process of separation from his mother. In the context of case described here psychoanalytic literature about modern psychopharmacotherapy was reviewed. The action of medication on symptoms of particular disorder is not equivalent wit psychic change. The basic requirement for the psychic change to occur in the course of pharmacotherapy is the change in patient's internal object relations and relation to self. Because of that the longer period of continued pharmacotherapy is essential, not only for biological reasons, but also for this psychological process of changes and adaptation to occur. In the case described additional psychotherapy was important counterpart of pharmacological treatment in order to help the patient to experience and adapt to processes of changes in his self and object relations.