Abstract
Euthanasia is an uncomfortable topic for most of us and a universally acceptable resolution is inconceivable. Our December 2011 issue carried the significant paper by Nitschke and Stewart (2011). An eminent expert on suicide, Robert Goldney (2012), now invites reconsideration of the prevalent vocabulary. There are many gradations by which one individual can knowingly take part in the death of another, but the existing vocabulary fails to accommodate these. Goldney thinks the time has come to abandon words such as euthanasia or assisted suicide. He proposes ‘assisted death’ and ‘assisted dying’ to reflect more truthfully what is actually happening between the participants.
In an exhortative piece, Jureidini (2012) expresses his concern that psychiatry misrepresents suffering as sickness. The essence of his disquisition seems to be captured in the final two sentences. He wants to restore meaning to our specialty by helping patients come to an authentic account of where they are, inter alia. In a period when the neurosciences are so rapidly bringing scientific enlightenment to psychiatry, such views may have a countervailing value for retaining the empathic elements of good clinical practice.
Competence in the use of medication is deficient in our continuing education. This issue carries no fewer than six contributions to psychopharmacology. The magisterial paper on lithium by Malhi et al. (2012) deserves to have an effect on clinical practice globally. By spelling out the under-recognised strengths of lithium, the authors may help restore its therapeutic primacy. Moylan et al. (2012) take a hard look at alprazolam for panic disorder, with two accompanying, though not wholly congruent, Commentaries by experts in the field (Lampe, 2012; Starcevic, 2012). Regarding clozapine, it is not before time that steps be taken to make the monthly obligatory review less of an imposition on public clinics. The paper by Filia et al. (2012) is most timely.
Transcranial magnetic stimulation is increasingly visible as a promising treatment, so we welcome the evidence of Bradfield et al. (2012) for more accurate localization of the dorsolateral prefrontal cortex. A contribution from Huang et al. proposes that the response to antidepressants can be accelerated by this treatment (2012). The article by Kortrijk et al. (2012) from the Netherlands belongs to that important group showing how routine outcome data, so highly respected in the corridors of power, can be wonderfully misleading when confounders are naïvely ignored. But to this writer, the jewel of the month is the contribution of Jones et al. (2012) to what we should have known to be inevitable. Climate change has yet a further consequence: it has an effect on psychiatric phenomenology and that effect is already with us! To allay our anxiety, Brakoulias (2012) puts the finding into its wider societal context by looking at underlying mechanisms. We are encouraged by the energy deployed on the need to do better for people with long-standing psychoses. Now, McGorry et al. (2012) have responded to Trauer’s criticism (2012). For most of us, it will tax the mind to plot a course through the many propositions embedded in this topic. Bear in mind that the word ‘palliative’ is derived from the late Latin palliatus, meaning ‘cloaked, to disguise the enormity or offensiveness of’ (Onions, 1996). That, and its association with dying, should encourage adoption of a better descriptor.