Abstract
Darth Vader stood brandishing his red lightsaber whilst exhorting ‘… and one of them is not even a real doctor, he’s a psychiatrist!’ It was the annual great debate at the University of Sydney Northern Medical Clinical School hosted by the Associate Dean. The debate considered the motion ‘The surgeon’s wand is mightier than the physician’s potion’ and pitted a psychiatrist and a neurologist against a gynaecologist and a surgeon. A survey immediately prior to the debate had the physicians starting at a significant disadvantage with 59% in favour of the motion. Predictably, it did not take long for the ‘debate’ to descend into a schoolyard fray but interestingly, despite the impressive theatre provided by the surgeons, the physicians managed to ‘do an Obama’ and sway the swing voters, to win the argument with ultimately 83% opposing the motion. The victory was sweet but short-lived. It was a fun, light-hearted, jocular joust with much of it conducted in jest, but reflecting on the comments I could not help but think that many of the jokes identified a key issue at their core that is germane to the status of psychiatry.
Is psychiatry indeed a medical specialty? And irrespective of whether it is regarded as such, what is the impact of how it and its practitioners are perceived by their medical colleagues? These questions provide ample fodder for a debate in itself, but linked to this issue is how psychiatry defines itself. A core function of the profession is to define mental illness and presently, with the imminent release of DSM-5, psychiatry is re-examining its taxonomy. This topic of classification is featured strongly in this opening issue of 2013 with a number of Viewpoints (Brakoulias, 2013; King and Delfabbro, 2013; Marnane and Silove, 2013; Starcevic, 2013) and Debates (Malhi, 2013; Sachdev, 2013), and it will be revisited throughout the year with a new sub-section within Correspondence called DSM Digest. The latter aims to provide a succinct update of key changes within DSM-5 and comment briefly on how these might alter clinical practice and research. It is hoped that these commentaries will prompt discussion and further correspondence from readers.
Triggers for previous discourse within ANZJP are also featured within this issue of the Journal. For example, Starling and colleagues (2013) provide a useful broader perspective on psychosis in adolescence, and linked to this Power and colleagues (2013) tantalize with the finding that illicit substances cumulatively advance the onset of schizophrenia. However, Castagnini and colleagues (2013) caution against premature diagnosis and indicate the instability and ephemeral nature of acute and transient psychotic disorders. The prescriptive consequences of changing clinical practice are reflected in the article by Karanges and colleagues (2013), which reports on the pattern of psychotropic medication utilization in Australia over the past decade. This article is followed by thought-provoking correspondence, which includes a series of commentaries that tackle the attention-grabbing topic of attention deficit hyperactivity disorder (ADHD).
Returning our attention to our practice of psychiatry, with both art and science defining its clinical role, it is important to acknowledge The Royal Australian and New Zealand College of Psychiatrists (RANZCP), which has been a key player in developing many aspects of our profession. It is therefore fitting that as we reclassify psychiatry in the context of DSM-5, and in so doing consider our function, we should recount and celebrate the many achievements of the College over the past 50 years. Hence, both the ANZJP and Australasian Psychiatry will be featuring special articles throughout the coming year that highlight the contributions of the College.
May the College be with you.