For his narcotic dependency he was put on Suboxone which stopped his abuse of Hydrocodone and Oxycodone. In psychotherapy, it emerged that his penchant for getting into trouble with the law was a form of self-punishment for harboring unconscious evil thoughts towards his father. These two interventions: substitution of Suboxone (Bupronorphine) for street narcotics, and a realization that his ambivalence towards his father, for he loved his father very much too, was emerging against the local police, straightened his life considerably.
Once he squared up with the probation department and the court, and started showing up at his work reliably, he wanted some medication to straighten out his other problems - the teeth-grinding and the stomach churning. He bemoaned that the former kept him awake at night with sore jaws and the latter had him in knots during the day.
The Zoloft dramatically eased his queasy stomach, teeth grinding, and petty worrying.
The anxious worrying was replaced by obsessive daydreaming. He would play scenarios in his mind of his house catching on fire due to a careless mistake of his causing his pet cat to get roasted.
This explanation did not sound sufficient enough to produce the whole range of his obsessive symptoms. People witness fires destroying houses all the time yet it does not lead to their getting obsessively preoccupied with their own house burning down.
But not all his aggression towards his father had found this unadaptive outlet. Some of it had found expression in ego-syntonic and socially rewarding endeavors of beating the competition. He became a star athlete. And once when he was shipped off to Tennessee to live with his relatives to keep him out of the hair of the city's police department, he had gotten so good at baseball that his coach thought he would one day be a Major League player. Away from his father he could dare outshine him, at least on the baseball diamond. But something soured this healthy outlet for his aggression, and he started getting in to trouble in Tennessee too and had to return to Michigan. Back in his father's house where he had to abide by the latter's rules, he gave up baseball and was back on the streets challenging the police and getting arrested for speeding and doing drugs.
One thing for certain is that the SSRI ended the somatic anxiety of bruxism and stomach- churning and replaced it with checking and rechecking rituals, the cleaning mania, and daydreams of destructive scenarios.
So the SSRI had shifted the mode of expression of his aggression - from the soma to the psyche.
Does this tell us something about how SSRIs work?
Along with the disappearance of bruxism and the overactivity of the stomach the SSRI also improved his affective status. He was no longer as anxious, worrisome and inhibited. So with the shift of the problem - discharge of aggression from somatic to the psychic sphere - the affects lessened too.
For the man reported that the cure of his somatic problems and lessening of anxiety came with a price. He stopped feeling things deeply, his affective response to people and situation became flat and he felt like he was not quite in touch with the world. So one cannot do away with affects without taking away the feeling of being alive and human. As if the right combination and strength of affects gives us the sensation of being ourselves and as if each person has his own unique repertoire of affects which give him his individuality.
Even the somatic problem of stomach churning and teeth gnashing were not just wiped away. Some very deep somatic problems emerged in their place. The patient began gaining weight and began sleeping 10 to 12 hours a day. Granted they were not very painful but perhaps in the long run as destructive. It was surprising that he did not develop loss of libido, which is a frequent somatic problem with SSRIs.