A Farewell

As the 12th Editor of the American Journal of Psychiatry in 175 years, I feel honored to have held the role since 2006. Today I am pleased to turn the Editorship over to Ned Kalin. I look forward to reading this coming year’s issues and the next phase in the progress of the Journal. Ned is a talented, innovative clinician and scientist who can lead us forward.

There is much that I will miss. The Journal is a vast collaboration, with thousands of colleagues interested in mental disorders, from genes to the community, and infants to the aged. The reviewers who work tirelessly and anonymously, and the authors who entrust us with their work, often the same people in alternating roles, are the “college without walls,” as my teacher Daniel X. Freedman put it.

I am grateful to the members of the Editorial Boards for the past 13 years, who have guided me, contributed and solicited articles, and offered sage advice on difficult issues we have faced. Most new features of the Journal began as discussions with members of the Board.

A core group of Deputy Editors has responsibility for the many areas of psychiatry. We shared a biweekly call to discuss papers and make the final decisions as a group on what we should publish. Daniel Pine came with his enthusiasm for the newest discoveries in child psychiatry, Bob Michels interjected his wisdom of many years of clinical experience, David Lewis contributed scientific rigor, Carol Tamminga gave us her broad worldwide perspective, John Rush staunchly advocated for improved clinical practice, and Susan Schultz brought her wonderful humor that comes from working with the aged. I already miss the frank exchange among colleagues who have the highest respect for each other and the camaraderie of the occasional times we would spend together in person.

The Journal’s professional staff is headed by Michael Roy, our Executive Editor, a professional with an incredibly high level of skill and integrity. If you have ever said to me, as many have, “The Journal looks great,” it is the dedicated work of Michael and his staff that you are seeing. I will miss talking and planning with my partner Michael and calling to thank him, when each issue arrived in my mailbox and I could hold in my hand what we had created. John Guardiano, Heidi Koch, Susan Westrate, Angela Moore, Michael Pogachar, Linda LaCour, and Efrem Tuquabo are talented, dedicated people with whom I felt privileged to work on a daily basis, as we all made sure that papers were handled correctly and that each issue came together. I am grateful that Javier Escobar and Carlos López-Jamarillo decided that we needed a better outreach to our Spanish-speaking colleagues, and they enlisted Sergi Casals, who has graciously translated a summary of our articles each month.

Molly McVoy helped me start the Residents’ Journal as its first editor. Following her lead, residents write and edit their journal themselves and select yearly rotating editors. It has been a joy to see the talent and fresh perspective of our future leaders.

Thirteen years of daily work on the Journal takes time from people whom you love. My wife, Sari, was unfailingly understanding when I retreated many nights and weekends to work on “The Journal.” Her constant support made my work possible.

To the readers of the Journal, it has been my aim and the aim of all the editors and staff to bring to you each month the best information you can possibly have on the progress in our field, as it applies to how we help our patients today and in the future. Many of you have told me how an article or an issue has fulfilled that aim for you, and I have been grateful for your comments.

When Bob, Danny, Carol, Susan, John, David, and Michael asked me what I thought of the experience, I couldn’t answer. I was exhausted by the 13 years. What I enjoyed most was working with the editors and authors to help make articles be as informative as possible and to communicate to clinicians, other investigators, and families and patients what is important about what they had learned. I felt like a museum curator, trying to discern the best and help it be seen in a way that allowed others to appreciate it as well.

But I also felt the frustration of Dr. James Craik, George Washington’s physician for 40 years, summoned to what would be Washington’s deathbed. Dr. Craik administered the last of four bleedings to deplete Washington of the blood humors, thought since the writings of Hippocrates to be the cause of illnesses like Washington’s pneumonia. Vigorous bleeding was a treatment championed by Benjamin Rush, our honorary founder. Dr. Craik wrote in his diary that he knew that the treatment was wrong and was killing Washington, but he had no other frame of reference to guide alternative treatments.

Sixty years later, Louis Pasteur, working on the chemistry of fermentation, discovered that tiny organisms in the dregs of wine, first observed two centuries earlier, were actually producing its alcohol. From his frame of reference totally outside established medical dogma, he then made the stunning hypothesis that human disease must be the product of such organisms. It took nearly 100 years more for penicillin to be available to clinicians and patients. Bleeding had been practiced for more than 1,500 years with ever-increasing vigor, but it was a radical shift in the frame of reference that made infections treatable. Dr. Craik would be astonished, if not incredulous, that a mold might have cured Washington.

The magnitude of medical progress that our patients deserve cannot come solely from doing what we already do more vigorously. Like Pasteur, we need to view the problem from a different frame of reference. As Editor, I felt that I did some, but I regret not enough, to make a home for papers that challenged our accepted views with new perspectives on the causes and treatment of mental disorders. Such papers are rare, and they are often not appreciated when they first appear. I especially enjoyed the 175th Anniversary Reviews because many of the authors used the opportunity to provide new perspectives on their fields. We need to nurture the seedlings of our future and not let the massive oaks of our established knowledge shut them out.

I look forward to the new perspectives that Ned and his editors will bring in the next years, and I regret that I will not be around for the 250th Anniversary Reviews to learn what new frames of reference will allow our future colleagues to discover the penicillin for schizophrenia.