Understanding the impact of the COVID-19 pandemic on psychiatric trainees and what can help

The COVID-19 pandemic has increased rates of psychological distress and burnout in healthcare staff. How can we understand our experiences of the pandemic? We reflect on the experiences of psychiatry trainees in two north London mental health trusts. From a psychoanalytic understanding, states of extreme anxiety can lead to a manic defence and functioning in the paranoid–schizoid position. This position is derived from object relations theory and is characterised by binary thinking, splitting, projection, defensiveness and ‘knee-jerk’ decision-making. This can affect our perceptions, responses to others, relationships and ability to function and, therefore, our clinical practice and well-being. We consider the importance of recognising these processes and of organisational containment and having space to reflect. This supports functioning in the depressive position, a state of mind where we can tolerate anxiety, address difficult realities and develop new ideas. We hope these understandings are helpful to our colleagues in all professions.