Medication as Object

Abstract

People experience and treat medication as though it were a person: in other words, as an object. Among the many symbolic meanings attributed to medication, this sort of personification, or object representation, is a meaning that medication is uniquely positioned to contain and convey: imbued with intentionality and influence, medication moves beyond the sphere of static, iconic representation and enters the changeable, dynamic object world of action, aim, and agency. Unlike more generic or stereotypic meanings, object representations attributed to medication may reflect the patient's specific dynamics and object relations. These representations are many and mutable, and take on shifting and overlapping forms that evolve with the analytic process. Medication may represent a third person within the framework of an analytic treatment, expanding the analytic dyad into a triad and offering new transference paradigms to explore. The defensive displacement of transferential qualities and attitudes, or split-off parts thereof, from the analyst onto medication can serve as a powerful resistance to the awareness of the transference to the analyst. Clinical examples illustrate the utility and importance of the analysis of medication as object, for both patient and analyst, with particular attention to the transference.

Clinical Barriers to Effective Pharmacotherapy in Co-occurring Psychiatric and Substance Use Disorders

“…The concept that feelings about medications may derive from the transference toward the clinician has recently been described in several papers. 21,23 Conversely, negative responses to the clinician may impede a patient's ability to take medication in a proper manner. 30 When a "less poisonous" drug was introduced in the form of acamprosate (partly related to my wish to offer additional pharmacological support that felt less hazardous), the patient once again had a strong initial placebo response with magical expectations.…”

“…I tried to Clinical Case Discussion explore these similarities with her and to integrate her rapidly shifting experiences of the medication, alcohol, and me. 23 I also used a mix of supportive techniques (e.g., psychoeducation) to enhance reality testing 30 when I felt the patient was having strong, distorted reactions to the medication. For example, risks and benefits, side effects, and the mechanisms of action were discussed at the beginning and on several occasions later in treatment when the patient seemed to be experiencing the medication either as too dangerous or too weak.…”

“…20 In addition, the patient's emotional reaction to the clinician may be reflected in his or her response to the medication. [21][22][23] On the other hand, the opposite danger can occur: the clinician may unwittingly collude with the addictive behavior of the patient when there is a denial of harm. In this case, the clinician liberally dispenses large amounts of medication without anxiety, with little follow-up or monitoring.…”

Rethinking placebo in psychiatry: how and why placebo effects occur

“…Medications may be invested with notions of food, nourishment and care (Tutter 2006) or, in more paranoid contexts, poisoning: patients with psychosis can hold paranoid and masochistic beliefs about antipsychotic medication (Titelman 1999). Medication may also act as a comforter or security blanket.…”

Ego Psychological Contributions to Understanding Psychopharmacology and Clinical Practice in Social Work Education

“…The literature examines issues such as the subjective meanings medication has for clients and the transference/countertransference issues that arise in treatment in relation to medication (Bradley, 1990;Mintz, 2006;Tutter, 2006). Several scholars emphasize that manifest reasons that clients reject medication often mask underlying conflicts about their illness (Bradley, 2004;Davis-Berman & Pestello, 2002).…”