As a psychiatrist and psychoanalyst I agree with Dr. Puryear's view that medical psychiatry and psychodynamic thinking need to be
integrated when approaching the diagnosis and treatment of the seriously disturbed patient [“Bridging Two Worlds: Consulting in the Yates Trial,” TAP 36/3]. Although an overemphasis on one approach with the resultant exclusion of the other can lead to clinically limited assessments, there are times when the pathology of the patient requires the privileging of one approach over the other. This was the case with Andrea Yates, where the dimensions of a biologically based psychotic illness were the most clinically relevant considerations. I would even go so far to say that psychoanalytic training or thinking was of no practical relevance in this case and that Dr. Puryear's “psychoanalytic” expertise was appropriately overlooked.
Although I think it was her intent to discuss the positive role that psychoanalytic training has played in her professional development, there is a secondary, perhaps unintentional, message running through her article. She implies that psychoanalysts are uniquely equipped to integrate models because of their training and hence [are] more likely to be clinically correct than the generic “non-psychoanalytically trained” general psychiatrists to whom she refers.
The majority of psychiatrists who work with the bio-psychosocial model would take issue with this clinically chauvinistic position and would strongly disagree with the suggestion that psychoanalytic training uniquely determines a clinician's ability to understand a patient's inner life or to determine the presence of psychosis. As Dr. Dietz is not viewed within forensic psychiatry as representative of mainstream positions her choice of him as the typical general psychiatrist is a caricature.
In my view this represents an attitude commonly conveyed by psychoanalysts [that] has played an important role in estranging general psychiatry from psychoanalysis and generating anti-analytic attitudes. For the benefit of our field, we need to be more self-monitoring [of our] tendency towards self-aggrandizement and the devaluation of others who do the same work we do without our analytic training.
Jamie L. Feldman, M.D.