Diversity of opinion is alive and well in the ANZJP

In recent years, there has been increasing concern among some academics about the lack of viewpoint diversity in universities, particularly in North America. This concern has arisen because academics are much more likely to hold liberal than conservative political and social views. It has been argued that this is an unhealthy situation, because multiple perspectives are needed to solve problems and lack of viewpoint diversity has led to some perspectives becoming taboo in universities. In an effort to promote greater viewpoint diversity, some scholars in the United States have founded an advocacy group called The Heterodox Academy. Similar concerns in Australia have led to the founding of the online magazine Quillette to promote ‘free thought’ on academic issues, and the reach of this publication has spread internationally.

The controversy over viewpoint diversity has led me to reflect on how the Australian & New Zealand Journal of Psychiatry (ANZJP) stands in this regard. As a publication owned by a professional college, there is a potential risk of privileging views that meet the professional interests of psychiatrists over those of other professions or users of mental health services. My position as the only non-psychiatrist out of the eight members of the editorial team gives me a good perspective to evaluate the journal’s tolerance, or even encouragement, of viewpoint diversity. I am pleased to report my experience that the editors are refreshingly open-minded and keen to see controversial issues presented and debated. This is seen in the Viewpoints and Commentaries that feature in every issue of the journal and constitute what is arguably the most interesting content for readers. The current issue is no exception, as the following examples illustrate.

Antipsychotic medications undoubtedly have a useful role in the management of psychotic disorders. However, they have significant risks as well as benefits. Bastiampillai and colleagues (this issue) raise the risks of the rising use of these medications with children and adolescents. Experimental studies with animals and observational studies with human adults show that long-term use can lead to brain atrophy. These authors point out that the risks to the developing human brain are unknown and that greater caution is warranted in prescribing antipsychotic medications to children and adolescents.

Cosgrove and Jureidini (this issue) reply to a recent debate article by Dharmawardene and Menkes (2019) which argued that a report by the United Nations (UN) Special Rapporteur had an anti-psychiatry bias. Cosgrove and Jureidini respond that the UN report appropriately acknowledged the important role of biological psychiatric treatment, but attempted to balance this against human rights considerations.

Malhi and colleagues (this issue) raise concerns about the use of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression, using a case study to illustrate these. The concerns cover the lack of guidelines on the sequencing of rTMS and electroconvulsive therapy (ECT), the number of treatment sessions that are appropriate when there is no apparent benefit and the significant cost to patients when the treatment is lengthy and is not covered by national health insurance.

Finally, we have two commentaries which connect with the journal’s ongoing debates about the best way forward on preventing suicide. In a previous issue of the journal, Horgan and Malhi (2018) proposed an approach that psychiatrists could use to prevent suicide during high-risk periods, such as immediately following discharge from inpatient care. This proposal involves combining intensive therapeutic contact during the high-risk period with simultaneous use of two antidepressants to increase the chance of a response. Lachter and d’Abrera (this issue) argue that this approach takes insufficient consideration of patient autonomy, particularly where the patient is not severely impaired in decision making. They also see dangers in ignoring the psychodynamic factors involved in suicidal patients. The response by Lachter and d’Abrera illustrates that disagreements with the views of the Editor-in-Chief clearly have a place in the journal.

Shaffer and Sinyor (this issue) propose that there may be lessons for suicide prevention from the approach that has been successful in reducing colorectal cancer mortality. They argue that this success was due to a multipronged approach focusing not only on identification of at-risk individuals but also on universal population health approaches to prevention. They apply this thinking to prevention of suicide in a group with very high risk – people with bipolar disorder – arguing that ‘a focus solely on aggressive interventions in the highest risk groups is unlikely to be sufficient’. They argue for suicide prevention efforts for all people with bipolar disorder, as well as efforts to reduce risk factors such as socioeconomic deprivation in the population as a whole.

And finally, the Editorial by Malhi et al. in this issue gives a critical view of the state of play regarding pharmacotherapeutic specificity that focuses on quetiapine. This piece is sure to provoke readers’ thinking.

Undoubtedly, as readers, you are likely to formulate your own views on these and many other matters featured in the journal, and some of you may even vehemently disagree with what has been expressed by the various authors within the ANZJP. If so, and you would like to see your views in print, then consider contributing to the journal – your submissions are most welcome, particularly where they relate to ongoing issues and themes in the journal. The ANZJP is not an ‘open access’ journal per se, although you can have your articles published in this style if you wish, but it is definitely accessible and open to viewpoint diversity, as demonstrated clearly by this month’s articles.