Looking Back: A Year in Review

In the February 2020 issue, H. Steven Moffic, MD tackles the complex inter-related phenomena of increased uncontrolled wildfires in both the United States and Australia, the continued lackluster global acknowledgment of and response to the serious escalation of climate change, and physician burnout.

Drs Nidal Moukaddam and Asim Shah’s cover story for the March 2020 issue introduced us to COVID-19 early in the pandemic when, at the time the article went to press, there were a little more than 80,000 reported cases of COVID-19 worldwide. Today’s (December 12, 2020) data base from the Johns Hopkins Coronavirus Resource Center (coronavirus.jhu.edu) reports 71, 430, 885 globally confirmed cases with 1,600,995 global deaths. The authors instructed us about the importance of disinfection, hand washing, wearing masks, COVID-19 testing, and the development of new treatments and vaccines.

As April is Sexual Assault Awareness Month, Drs Joan Cook and Amy Ellis authored a review about the often neglectedtopic of sexual abuse in males. They begin with the staggering statistic that 1 in 6 boys are sexually abused before age 18. They discuss the importance of reframing the narrative of this experience by men as that of being survivors of abuse, and not victims. They presented recommendations of how to interview men about possible past sexual abuse, approaches of how to work with male survivors, and the range of treatment options available.

The May 2020 issue featured a controversial cover story by Drs E. Fuller Torrey and Robert Yolken, who opined that the National Institute of Mental Health has shifted its priorities away from new drug development, especially for schizophrenia and bipolar disorder, and towards basic brain research. Through Psychiatric Times email correspondence between Dr Torrey, Dr Yolken, and the NIMH, it became clear to us that this issue is a complex story. It deserves a lengthier discussion between these 2 parties far beyond what an article in Psychiatric Times could cover.

In the June 2020 issue, Editor in Chief Emeritus of Psychiatric Times, Dr Ronald Pies, tackled a salient issue that could no longer be suppressed in his cover article “Culture Wars, COVID-19, and Countertransference.” He explores the societal divisions that have festered since the 2016 presidential election and have emerged with ferocity during the COVID-19 pandemic. The result has been anger, rage, and violence projected onto some basic and established approaches to mitigate the pandemic: wearing masks, social distancing, hot zone lock downs, and sheltering in place. Dr Pies question is for us in psychiatry: how do we maintain awareness of and manage the countertransference that arises when our patient’s beliefs are opposite to our own?

Erin Smith et al present an ambitious model in the July 2020 issue for how psychiatry could evolve moving forward to optimize diverse cutting-edge fields of study, alongside traditional basic science and clinical practices to best serve individuals with mental health issues. They define a comprehensive collaborative approach including specialists both outside and inside of the medical profession to create a new treatment paradigm called “Convergence Mental Health.”

The cover story in the August 2020 issue was co-authored by “Seven Psychiatrists Against Racism,” a multi-racial group of psychiatrists committed to the elimination of all racism as an ethical necessity and priority. A general introduction narrates the 400-year history of racism in the United States as well as in psychiatry. This is followed by each author writing individually about an issue in racism that is important to them, and often originates from their personal experience.

September brought with it significant stress and uncertainties for parents and children throughout our country. Seven months into the pandemic, and after the usual summer school vacation, there was no lack of strong opinions over how the transition back to school should proceed. Educators, psychiatrists, pediatricians, politicians, parents, and students were all entering into uncharted territory, and understandable fears and disagreements surfaced. In this issue, child and adolescent psychiatrist Dr Abhijit Ramanujam contributed a thoughtful overview of the many COVID-19 related challenges facing children, adolescents, and parents: are children at risk for viral infection and serious symptoms; can children transmit the SARS CoV-2 virus; how should schools be re-opened or re-closed; what are the effects of home schooling on a child’s social, emotional, and academic functioning; and what are special considerations for a child or adolescent with a psychiatric disorder?

The month before any presidential election can be a time of significant anxiety, and that was certainly the case this year. In the October issue H. Steven Moffic, MD, authored a timely cover commentary reviewing “Presidential Election Anxiety.” Dr Moffic reviews the diverse elements of election anxiety, as well as its neurobiological and evolutionary underpinnings. This is followed by a historical stroll through the contributors to anxiety during many of the presidential elections starting in 1920, at which time the Spanish Flu pandemic was winding down, to the present election. He concludes with a discussion about psychiatry’s role in managing our own, our patients, and societies election anxiety.

The COVID-19 pandemic has intruded into every aspect of our lives. Not surprisingly, this is the fourth issue in 2020 that I am commenting on a COVID-19 related cover article in Psychiatric Times. November’s cover story, authored by Dr Michael W. Jann, reviewed the neuropsychiatric and medical sequelae of COVID-19. We remain under siege by this pandemic, and it will likely take years to fully understand the short and long-term sequelae complicating the full recovery from the initial viral infection. Dr Jann reviews what little we know to date, and then extrapolates what we may encounter based on well established studies from patients who recovered from sepsis, patients who spent time in an ICU for acute respiratory distress syndrome (91% required ventilation), and patients who developed post-intensive care syndrome. Psychiatrists are already treating a range of psychiatric disorders post COVID-19, and Dr Jann concludes by reviewing the enduring symptoms of PTSD, depression, and anxiety in individuals traumatized by 9/11 and Hurricane Katrina.

To conclude a difficult year, Dr H. Steven Moffic – a frequent contributor to Psychiatric Times – wrote a commentary offering the possibility of optimism as we say good-bye to 2020, and welcome 2021. The pages of next year’s articles are currently blank. Let us be mindful that each of us have the power and responsibility through our thoughts and actions to write the words that will fill these pages. Be safe, be well, be kind, and thank you for your ongoing support of Psychiatric Times!