Introduction: Deep Dives and Intellectual Jujitsu

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According to Roget’s Thesaurus, to controvert “is to oppose with logical reasoning, to dispute or contradict”; even more literally in the Latin it means, “turned against.” Hence came the disputations of medieval theologians and the point-counterpoint of the Summa of Thomas Aquinas. In this 2-part Special Report on Controversies in Psychiatry, we offer our modern version of such point-counterpoint.

But first a bit of a clarification. Cable television and social media have taken the academic shine off of controversy and sullied it with scandal. True controversies, such as those we will examine in this Report, are substantive clinical issues about which there is real and serious disagreement among experts. Political controversy, as we have sadly seen these past few months, can be a sign that the social body is ailing. But respectful debates about substantive topics are signs of curiosity and imagination signaling health of mind-or in this case the community of minds that is psychiatry.

Gauged by this measure, psychiatry is very well indeed, for the most difficult part of chairing this Special Report was how to choose from the dozens of controversies our outstanding editorial staff developed.

The articles in part I examine some of the most intriguing questions. Strong evidence supports sound arguments on each side of each topic.

The first set of articles addresses assisted outpatient treatment (AOT), a topic that may not seem like a controversy to many of our readers. The authors of the 2 articles suggest that there are salient counter-claims about AOT that strike the fundamental chord of mental health ethics: the conflict between beneficence and autonomy, and between paternalism and liberty that deserves a hearing and thoughtful response.

The second issue addressed is the debate over the use of antidepressants in pregnancy-another contemporary clinical dilemma in which practitioners often fear they have no viable options. Lauren Osborne, MD, Katherine McEvoy, MB ChB, and Jennifer Payne, MD, show that empirical data and shared decision-making offer a number of reasonable strategies.

Neuroscience has more than proved that engaging in challenging mental exercise is key to the longevity and vitality of the life of the mind. So we invite readers to join us in this age-old intellectual jujitsu, which has been an essential part of the training of rabbis and lawyers, philosophers, and-yes-physicians.

Disclosures:

Dr. Geppert is Professor of Psychiatry and Director of Ethics Education, University of New Mexico School of Medicine; and Chief, Consultation Psychiatry and Ethics, New Mexico VA Health Care System, Albuquerque, NM.