On Taking the Helm

February 1, 2007

On Taking the Helm

February 2007, Vol. XXIV, No. 2

"An editor is someone who separates the wheat from the chaff and then prints the chaff.”- Senator Adlai Stevenson

As the new editor in chief of Psychiatric Times, I find myself at once exhilarated and humbled. I am exhilarated because there is a wealth of psychiatric knowledge that we may confidently share with both our colleagues and our patients. I have in mind not only our burgeoning understanding in the biological sphere, but also the wisdom that our profession draws from psychology, philosophy, sociology, and various spiritual traditions.

It is no small mark of psychiatry's progress that one of “our own,” Dr Eric Kandel, shared the 2000 Nobel Prize in Medicine for his seminal contributions to the field of neuroscience. It is also worth noting that Dr Cynthia Geppert, who writes a column titled “Windows” on spiritual matters for this paper, also received a prestigious award last year: the Hearts and Hands Award, given by the Secretary of Veterans Affairs to physicians who provide exceptional, compassionate, and sustained care to America's veterans. Psychiatry, in short, is a “big tent” in which-to paraphrase one of my teachers-you can do biology in the morning and theology in the afternoon.

At the same time, I am also humbled by the difficulty of sorting out just what is truth in our field-or rather, which truth among the multitude of truths deserves to be emphasized. Consider the plethora of controversies facing psychiatry today: Does so-called biological psychiatry amount to crude reductionism, or is it the crucible within which our understanding of the human brain has flourished? Has psychoanalysis failed to demonstrate its efficacy, or does it remain an invaluable tool in our professional armamentarium? Is research that is sponsored by pharmaceutical companies inherently biased, or has it greatly enhanced our understanding of psychotropic medications?

Are our prescribing practices for children and adolescents founded on evidence-based medicine or on “medicine-based evidence”? Is the Veterans Affairs system providing adequate mental health care to our soldiers returning from Iraq, or is the system woefully unprepared for the task? Is managed care helping or hindering our patients' well-being? Is the use of costly atypical antipsychotic agents justified by their supposedly improved efficacy and tolerability, or have we been seduced into thinking so by clever marketing hype? I could continue in this vein for at least another page or two-but I suspect you understand my point.

Resolving such controversies is not easy. In my experience, if you put 2 psychiatrists in a room, they will usually emerge with 3 opinions. This is not necessarily a bad thing. Indeed, I confess to a generally conciliatory frame of mind, one that tends to see merit on both sides of a controversial issue. This willingness to consider a variety of conflicting viewpoints has been one of the hallmarks of Psychiatric Times since its founding. Looking through our online archives of articles, I note such titles as, “More Kids on Drugs: Is the Research Worth the Furor?”; “The Debate Over Medical Error Reporting”; and “Rumble in Reno: Psychopharmacologic Nihilism” (a point and counterpoint).

I believe this openness to divergent points of view has been the great legacy of my friend and colleague, Dr John Schwartz. While John will be irreplaceable in so many ways, I fully intend to carry on the tradition of providing a fair and open forum for controversial ideas. But, as I believe John would agree, a reflexive evenhandedness is not an editorial virtue. A publication that bends over backwards to be “fair” risks losing its backbone. Psychiatric Times has never been afraid of speaking truth to power. It has always embraced a core set of scientific, medical, and ethical principles that we must continue to uphold and defend. For example, this publication has always held, implicitly or explicitly, that psychiatry has a unique and critically important role to play in the overall scheme of medical care.

Indeed, I believe that our integrity as a medical specialty must be defended against an array of adversaries who either demean our scientific credibility or seek improperly to acquire our medical prerogatives. To hold to this is surely not to deny that we have a great deal to learn as a profession; nor is it to turn a deaf ear to our critics. But listening to one's opponents is not the same as caving in to them. Finally, we must also resolve to be unwavering advocates in behalf of our patients, few of whom are well served by commercial interests that steadily erode our medical autonomy.

In many ways, Charles Dickens' description in A Tale of Two Cities has an oddly prescient ring for our own age: “It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us.”

Today these same antinomies confront us in our little sphere of psychiatry. How our profession deals with them may have lasting effects down the ages, for our patients and for us. Adlai Stevenson notwithstanding, Psychiatric Times will continue to work to separate the wheat from the chaff-and print the wheat. We will do our part to uphold the core values of our profession and to provide our readers with the critical information needed to accomplish this.

Dr Pies is clinical professor of psychiatry at Tufts University in Massachusetts. His most recent books include Creeping Thyme, a collection of poetry (Brandylane Publishers); Zimmerman's Tefillin, a short story collection (PublishAmerica); and Handbook of Essential Psychopharmacology, 2nd edition (American Psychiatric Publishing).