Tablets and talking—A spurious contrast in psychiatry

Abstract

Pharmacotherapy and psychotherapy of psychiatric patients are not given equal appreciation. Particularly in syndromes with marked psychogenic or psychosocial overtones, psychotherapy is regarded as the causal therapy par excellence. In these cases (the vast majority), psychotropic drugs are believed to have at best a symptomatic importance and to entail the risk of effacing the true causes. I consider this view to be as unfelicitous as it is wrong, because: (1) Psychosocially determined behavior disorders, too, have a neurochemical substrate; (2) It is by all means sensible to make an attempt to normalize behavior by correction of this substrate; (3) Normalization of the cerebral substrate with the aid of pharmacotherapy is no less a causal type of therapy than is reduction of the pathogenic input with the aid of psychotherapy; (4) This means that pharmacotherapy and psychotherapy are complementary, and that each separately is an incomplete therapy.

This argument is valid where psychotropic drugs with a relatively specific effect are available, as they are for the vital depressions and psychoses of the schizophrenic type. In these groups of patients, empirical findings confirm the theoretical expectation formulated (4) above. It is postulated that, for the treatment of neuroses which has so far been based entirely on psychotherapeutic intervention, much is yet to be expected of future developments in psychopharmacology.