Author reply to Letter to the Editor regarding ‘Defending and demonstrating the psychodynamic orientation in psychiatry’

To the Editor

I agree with the sentiment in the respondents’ exhortation for us to recognise our positionality and be more reflexive as psychiatrists, especially those who are proponents of a psychodynamic orientation. This could obviously extend beyond an appreciation of backgrounds and contexts that are not Western, educated, industrialised, rich and democratic. It could also include backgrounds and contexts related to Indigeneity, race, gender, sexual orientation and other forms of lived experience. I agree that psychiatry and psychodynamic orientation need to avoid ethnocentrism, racism, sexism, homo- and trans-phobia, and other forms of prejudice.

However, I strongly disagree with the respondents’ description of the biases or limitations of the psychodynamic orientation in contemporary theory and practice. The respondents’ arguments refer to Freud’s position in the first half of the last century and other psychoanalytic movements from over 50 years ago. This is anachronistic. In recent decades, psychodynamic and psychoanalytic thinking has expressed, engaged with and explored difference in many forms, including, inter alia, cultural, sexual and gender difference; the experience of Indigenous peoples; and the role of complex, intergenerational, relational, cultural and attachment trauma in its many forms. It has engaged with the situations of homeless, asylum-seeker, refugee and other marginalised groups.

There is an extensive and growing literature looking at the interface between psychoanalytic and psychodynamic orientations with transcultural mental health, gender studies, settler-colonial studies and traumatology, among other things. This is not the space to refer to this vast literature beyond mentioning, in passing, the programme of our very own Congress this year, where psychodynamically oriented practitioners were keynote speakers, session chairs and speakers along those lines. I could also draw the respondents’ attention to numerous anthologies such as Krause (1998), Dimen (2011) and Gerlach et al. (2013) or the rich output of journals such as the International Journal of Applied Psychoanalytic Studies. There are a vast array of studies, articles and research projects both within psychoanalytic studies, in cross-disciplinary research, and from other disciplines adopting psychodynamic approaches and theory.

In all of this, my concern is that the respondents’ position incorporates a straw man argument, and I am also concerned that the description of a certain positionality as WEIRD is too simplistic, and to some, including myself, it could even sound inappropriately whimsical. The positionality of theorists and the topics with which they engage, or of practitioners and the people with whom they engage, is more complex than this. Reflexivity, sensitivity to positionality and respectful awareness of forms of difference and intersectionality in the space need to be practised in more depth, and I would suggest that the psychodynamic orientation can facilitate this.