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Dr. Carl-Ivar Dahl's paper is most timely and relevant for psychoanalytic practitioners, particularly in metropolitan areas where new immigrants and refugees are converging today from many areas of the world. The immigrant poses a number of problems for the mental health practitioner, having to do with language and cultural differences, so called culture shock, and differences in values and life orientation. Dr. Dahl's paper has evoked many thoughts in me, and I will address some of them in what follows. I will discuss transcultural issues, the refugee population as an immigrant group, issues of ethno-centrism as an extension of narcissism, language related issues, and the function of the triad.
Psychoanalysis with persons of different cultures is not an issue new to the field as it occurred massively with the migration of European analysts to the United States. Although most European analysts not only adjusted well but indeed thrived in North America (South America as well), I believe a split occurred in psychoanalysis as a result of this transculturation. The result was the birth and development of the neo-Freudian, culturalist, or revisionist schools of Karen Horney, Harry Stack Sullivan, and others. The excision took place in part because of the very difference in context for the psychoanalytic practice, and in part because of the lack of flexibility traditional to mainstream psychoanalysis.
This dogmatic rigidity did not have the resources to cope with the dramatic change in cultural context. The Freudian establishment continued to feel that it was necessary to protect the young discipline from what had been experienced initially as a hostile scientific environment. While this was true and commendable during Freud's time, it was certainly not the case in America where psychoanalytic thinking held the sway in psychiatry until quite recently.