The radical psychiatry movement of the 1960s and 1970s challenged the medical model of psychotherapy, positioning alienation as the root cause of all mental and social distress. Both cause and solution were seen as residing in social relationships. Currently, we are seeing a rise in political tyranny in many quar- ters of the globe. This has inspired political engagement because of polarizing positions. In society this encourages passion for values as well as hatred and intolerance of otherness. The author proposes that intolerance feeds regressive defenses such as projective mechanisms and splitting, and she explores these in relation to alienation. In the search for a contemporary perspective, she offers the pursuit of social, political, and psychological pluralism within a radical relational psychiatry.