Turning Over the Helm: Hail-and Farewell

Readers who know me well will not be surprised by my citing the Tao Te Ching-but some may be taken aback by my quoting football legend, Kurt Warner, who announced his retirement recently.¹ Mr Warner had some wise things to say about leaving a job under your own steam, while you are still in good health-and preferably, before you are shown the door. As I prepare to step down from the editor in chief position at Psychiatric Times in June, I believe I can honestly claim that these conditions apply to my departure. The “hail and farewell!” is intended to encompass both my leave-taking from the helm and my greetings to the incoming editor in chief-my friend and colleague, James Knoll, MD.

For the past nearly 4 years, it has been my great privilege to occupy the position first held by our founding editor, John Schwartz, MD, who began this publication a quarter century ago. I was also privileged to work with 2 stellar editorial directors-first, Leo Cristofar, and later, Sue Kweskin. Sue has been ably assisted by Natalie Timoshin, Cortney Mears, Heidi Duerr, and Laurie Martin, whose hard work has polished so many informative, but sometimes rough-hewn, manuscripts. It has also been my privilege to work with an excellent group of regular writers, columnists, and-most recently-bloggers.

I suspect that in 1985, even John Schwartz could not have foreseen all the changes the field of psychiatry would undergo over the ensuing decades nor have imagined that the paper he founded would someday materialize on a computer screen, almost contemporaneously with a writer’s completion of an article. Indeed-for better and for worse-the momentous changes in American psychiatry have roughly paralleled the exponential growth of the Internet, with all its promise and peril.

The emergence of managed care, the growing influence of the pharmaceutical industry, the increasing dominance of “biological psychiatry,” and the diminishing role of psychotherapy training and practice-all these burgeoning (and many would say, baneful) trends were merely seeds of possibility in the early 1980s. So, too, with the increasing competition facing American psychiatry, stemming from the widening practice patterns of other health care professionals-including some who claim medical knowledge heretofore considered the province of physicians.² Almost in parallel with these trends, we have witnessed a profusion of Internet-based Web sites proffering views and information on all matters relating to mental health. Some of these Web sites offer helpful and accurate information, even when they are critical of the psychiatric profession; others, alas, are essentially launching pads for strident, antipsychiatry screeds.

In the face of these tumultuous trends and changes, Psychiatric Times has remained true to its roots-as a balanced, objective, and reliable source of information for psychiatrists and other mental health professionals. During my tenure as editor in chief, the “paper” has become a widely accessed, internationally available Web site (www.psychiatrictimes.com), with several hundred thousand “page hits” per month. We have also become, in my view, the paper of record, in the contentious debate surrounding the development of the DSM5.³ When a new controversy arises regarding the DSM5 process, you will probably “read it here first”-a source of journalistic pride for our editorial staff, if also a venue for heated debate among some valued colleagues.

How can a man’s life keep its course, if he will not let it flow?
-Tao Te Ching

Psychiatric Times, unlike many professional journals, is sent to psychiatrists free of charge. The trade-off for this publication is our reliance on advertising revenues-mostly from pharmaceutical companies. As critics of so-called Big Pharma have repeatedly pointed out, such advertising revenues may constitute a conflict of interest for any journal or newspaper. Rather than evade this issue, Psychiatric Times has faced it head on, through a number of recent editorial policies and procedures. So far as I know, we were the first psychiatric journal-and still one of the few-to require all editorial board mem-bers and regular writers to post financial disclosure statements online. We have also developed guidelines for what constitutes a conflict of interest⁴ and have initiated a reader-driven “watchdog” column, entitled, Pharmonitor.⁵ Finally, we are also in the process of appointing an editorial board member to monitor the scientific accuracy of advertisements placed in Psychiatric Times. None of these safeguards eliminates a potential or actual conflict of interest for us-but we believe these steps go a long way toward that goal.

In short, I’m very proud of what we have accomplished together-editors, writers, and readers all-over the past 4 years. I have no doubt that my learned colleague, James Knoll-a superb legal scholar, writer, and clinician-will continue to advance the ethical and educational goals of this paper, and to serve our readers with integrity and distinction. Dr Knoll will be assisted by an editorial board that continues to impress me with the wisdom and collegiality of its members.

Some readers might be curious about my own plans, as I step down from my present position. I’m happy to say that I’m not really “going” anywhere-I will remain on the editorial board (at the pleasure of our new editor in chief, of course), and I hope to continue providing occasional Op-Ed pieces and columns. But, as the quote from the Tao Te Ching may intimate, I am also looking to change the course of my life, in a significant way.

I was always excited about the next season. Now I’m excited about the next chapter. . . .
-Quarterback Kurt Warner, upon retiring from football

Readers of my work in recent years have probably detected a shift in focus, as compared with my writings from the first 20 years or so (has it really been that long?). I began my writing career with Psychiatric Times in 1985, with the submission of a rather quirky short story-and John Schwartz was bold enough to publish it! I gradually shifted my interest to psychopharmacology and consultation-liaison psychiatry; indeed, many readers came to know me through my Clinical Puzzle pieces. In a sense, I have come full circle, with my interest now turning back to the humanities, in particular, to the relationship between psychiatry and the realms of philosophy and spirituality. I now hope to devote most of my time studying and writing about such matters, focusing on my long-standing interest in Judaic philosophy. My current project is a study of the psychological insights of the Talmud, which I hope will eventuate in a book. Frankly, I am not quite sure where these spiritual pursuits will lead me-or into what new fields of endeavor. But as the ancient text asks, “How can a man’s life keep its course, if he will not let it flow?”

And so-hail and farewell!

TO RON PIES:  COMMENTS

Dear Ron,

When I read of your future journey I sought some wisdom from the Talmud and came across this saying: “Every blade of grass has its angel that bends over it and whispers, ‘Grow, grow.’”

I thought of what Thoreau said about why he decided to live in a pond-side cabin:

 “I went to the woods because I wished to live deliberately, to front only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived. I did not wish to live what was not life, living is so dear; nor did I wish to practice resignation, unless it was quite necessary. I wanted to live deep and suck out all the marrow of life, to live so sturdily and Spartan-like as to put to rout all that was not life, to cut a broad swath and shave close, to drive life into a corner, and reduce it to its lowest terms, and, if it proved to be mean, why then to get the whole and genuine meanness of it, and publish its meanness to the world; or if it were sublime, to know it by experience, and be able to give a true account of it in my next excursion.

Thoreau lived at Walden two years, two months and two days attempting to transcend his senses at attain a higher understanding of life.  He wrote about a two week trip he and his brother took, compressing it into one week, and began Walden which compressed the two years into one.  He also wrote about the night he spent in jail, acting from principle, in Civil Disobedience.  Then he moved on, writing:  "I left the woods for as good a reason as I went there. Perhaps it seemed to me that I had several more lives to live, and could not spare any more time for that one."

He summed up what he had learned at Walden in the Conclusion to that book:

I learned this, at least, by my experiment; that if one advances confidently in the direction of his dreams, and endeavors to live the life which he has imagined, he will meet with a success unexpected in common hours. He will put some things behind, will pass an invisible boundary; new, universal, and more liberal laws will begin to establish themselves around and within him; or the old laws will be expanded, and interpreted in his favor in a more liberal sense, and he will live with the license of a higher order of beings. In proportion as he simplifies his life, the laws of the universe will appear less complex, and solitude will not be solitude, nor poverty poverty, nor weakness weakness.

If we take the journey in life that we imagine, despite conventional dictates, then we will succeed in undreamed of ways.

This is to wish you good fortune and all the best on your imagined journey.  You have heard the angelic call of the blade of grass.

            Yours, Mike Sperber, MD

 -----

Prince of editors, scholar, and a wise man for all seasons. Under your leadership, Psychiatric Times has become the voice of our profession. Your publication of all sides of the DSM-5 debate is just one small example of your ability to spot the most important issues in our field and present them in the most thorough and objective way.

We look forward to your Talmudic research. After completing your labors for us, you are now able to fulfill Tevye's dream. 

All the best.

Al Frances, MD

------

 Dear Ron,

I read with great interest your parting editorial. You give inspiration to those of us who, like you, are in transition--and therefore I am very pleased to see the quotation that it's just not a matter of the next season, but that there is a next chapter.

Mission accomplished.

With all my best and great respect for your editorial and literary talents,

Hagop Akiskal, MD

Distinguished Professor of Psychiatry and International Health University of California at San Diego, La Jolla, California

References:

References

1. Maske M. Warner announces retirement. Washington Post. January 29, 2010. Accessed April 1, 2010.
2. Pies R. “Prescribing psychologists”: practicing medicine without a license? Psychiatric Tmes. March 29, 2010. http://www.psychiatrictimes.com/display/article/10168/1545667. Accessed April 1, 2010.
3. Couch in Crisis. Psychiatric Times. http://www.psychiatrictimes.com/blog/couchincrisis. Accessed April 1, 2010.
4. Pies R. Deconstructing “conflicts of interest”: a user’s guide. Psychiatric Tmes. November 24, 2009. http://www.searchmedica.com. Accessed April 1, 2010
5. Pies R. Pharmonitor: Reality-checking and journalistic integrity. Psychiatric Tmes. March 4, 2009. http://www.psychiatrictimes.com/display/article/10168/1384742. Accessed April 1, 2010.