Thanks,thoughts and other things: On being the Editor and what it brings

All that we are is the result of what we have thought.

Buddha (563 BC–483 BC)

Introduction

In this, my last editorial as Editor of the Australian & New Zealand Journal of Psychiatry (ANZJP), I thought it apt to review some aspects of my experience of being the Editor of the Journal for the past decade. I have therefore discussed a range of topics and provided some personal observations. To structure my reflections, I thought it best to begin with Thanks then move through some Thoughts, and onto Other Things.

Thanks

Editorial team

Although the role of editor is extremely demanding, or at least it can be if you choose it to be so, it can certainly be made easier by having like-minded and equally committed colleagues. In this regard, I was fortunate to have ‘inherited’ some star players, who from the very beginning put in maximal effort (see Figure 1). These included seasoned champions such as Scott Henderson (ANU) and Tony Jorm (University of Melbourne), who between them had decades of experience and knew everyone of note in antipodean psychiatry and probably beyond. Thankfully, Richard Porter (University of Otago) also remained, and as a contemporary, with similar background and training from the United Kingdom, he provided a valuable gateway to New Zealand psychiatry. In quick succession, I then recruited Michael Berk, Philip Boyce and Cherrie Galletly, who between them gave a voice to different interests and brought with them access to a whole new set of academic and clinical networks. The fact that they hailed from different universities (Deakin University, University of Sydney and University of Adelaide) in different states (Victoria, NSW and SA) certainly helped. Finally, some years later, Roger Mulder (also from the University of Otago), who had previously served as a Book Review Editor, re-joined and added to the ‘Magnificent 7’, making it the ‘Awesome 8’! And since then the Dream Team has remained unchanged.

Figure 1.

Editorial Team ‘Unmuted’. Cherrie Galletly, Roger Mulder, Michael Berk, Tony Jorm, Gin Malhi, Scott Henderson, Richard Porter, Sonia Bartoluzzi and Phil Boyce.

This consistency has been a key strength of the Journal, in addition to the experience and expertise that each of the Editors brought to bear. Continuity over time has allowed the development of a strong sense of camaraderie, collaboration and commitment. Everyone in the team always pulled together and felt that they were contributing meaningfully. As a consequence, each of us has gained a justified sense of pride in the achievements of the journal. This collective ownership of the journal has also furnished the ANZJP with a strong sense of purpose and a combined ‘conscience’. We have all wanted the journal to succeed and for its success to impact both academia and clinical practice. Fortunately, this has been achieved.

As with all teams, there is a captain and, as Editor, I have happily led from the front when necessary. But this has only been possible because everyone in the team has allowed me to do so. Indeed, it is important for me to note that every one of my Associate Editors would have been equally capable of leading the journal; however, they have all actively chosen not to, and instead graciously put their energies towards supporting me and towards pursuing our common goals. For this, I am forever indebted.

Another key member of the Editorial Team, and without whom the journal would not have been able to function (literally), is my Editorial Assistant – Sonia Bartoluzzi. Needless to say, Sonia and I worked closely, and together we eventually found a style that was mutually beneficial. At times, this meant being available at all hours and in all places. For example, on one occasion, in order to meet a deadline we finalised the edits to an issue by telephone while I was at a conference in the United Kingdom and Sonia, who was on holiday with her husband, was in a motorhome parked behind a European brothel. Apparently, it was the only place that had reliable Wi-Fi! It shows her resourcefulness and assiduousness, and again, I am extremely grateful to Sonia for her commitment and attention to detail, and for her immense patience at all times.

Setting goals

The ability to set and achieve a goal was facilitated by having a shared vision. In our early meetings, we discussed what the journal should look like, whom it should appeal to and what we should try to achieve. Setting goals such as an impact factor of 5, a broader readership and publishing a broader range of articles was relatively straightforward. The key ingredient, however, and one which was much more difficult to define, was to enhance the quality of the journal, increase its substance and real-world impact, in terms of both research and clinical practice, and ensure its content imparted genuine meaning.

This was certainly ambitious, but rightly so, and while the ultimate aim was more focused, the domains across which the journal had to succeed and have impact remained broad. For example, we wanted the ANZJP to be internationally significant in terms of its research and at the same time be of value to College members in terms of clinical practice. But it also had to appeal to some extent to audiences from outside of psychiatry, such as psychologists and general practitioners, and maintain relevance to psychiatrists at all stages of training and experience (Malhi, 2021). We also wanted the journal to play a role in advocacy, and again to do this at all levels, from patients through to government.

Global recognition

Recalling these early discussions, it was certainly a bold agenda and one which perhaps at the time we may have privately considered to be overly ambitious. However, somewhat to our own surprise, the journal has had impact across all of these domains at one time or another. Often, this has been difficult for us to appreciate, partly because of being in the thick of it. Hence, objective endorsement is invaluable, and recognition has come from colleagues both at home and overseas – at conference presentations and at institutions worldwide, for example, at Harvard, Yale and Columbia in the United States and at Oxford, Cambridge and King’s in the United Kingdom, in addition to many other prestigious and fine institutions across Europe and Asia. In many of these settings, the journal has often been compared with local publications, some of which have had higher impact factors and a much larger readership. However, in each instance, the quality of the research in the ANZJP, the absolute independence of its content and the steadfast adherence to providing a unique and alternative voice – one that forever strives to be true – have been repeatedly noted. Many of the leaders at these institutions have over the years provided encouragement and support and hence my sincere thanks in this regard to German Berrios and Gene Paykel at Cambridge; Guy Goodwin, John Geddes and Andrea Cipriani at Oxford; John Mann at Columbia; Sam Gershon at Pittsburgh; and Andy Nierenberg and Matcheri Keshavan at Harvard.

The Advisory Board and the anonymous horde

I, and the Editorial Team, and indeed the journal as a whole are also indebted to the numerous members of the Advisory Board along with the methodological advisors, without whom much of the work of the journal could not be accomplished. The names of these marvellous people have been published in every issue, but alongside these key individuals it would be remiss of me not to thank the many anonymous reviewers who have donated their time and expertise to assess papers as part of collegial peer review. Without their selfless contributions, there would be no way of gauging the quality of papers submitted to the journal, and in fact publication of the journal itself would simply not be possible. And although we acknowledge these referees annually by publishing their names in an issue of the ANZJP, I would like to take this opportunity to thank them once again for all their hard work and ongoing commitment to the journal.

Thoughts

The journal cover

Soon after I became Editor, the publisher of the Journal switched to SAGE and this provided me the opportunity to change the cover. Redesigning the ANZJP cover was tremendous fun. Having abbreviated its long title to the acronym ANZJP, an essential step towards making it more recognisable and easier to remember, all that remained was to determine how it should be displayed. I wanted the image to be distinctive and also serve as a logo, and so it had to be bold. Hence, the use of a clean font in striking blue (my favourite colour) was a straightforward choice. At the time, relatively few journals had plain white covers, but for the ANZJP this provided the perfect canvas, both for the title of the journal and for its publication date.

Separation of the page into two by the full title of the journal, which sat in a separate band, was inspired by the journal Bipolar Disorders, which also has a distinctive red line partitioning its cover. Below this line are the names of the editors. And so a similar placement was adopted for the ANZJP. However, this part of the cover also provided a creative space in which an eye-catching image could be inserted. Initially, I chose an image of the brain, for obvious reasons, but also because the mind (arguably the more important of the two) was a little more difficult to capture. But the image that was chosen was necessarily detailed, colourful and had depth so as to reflect sophisticated thinking and complex ideation.

Surprisingly (or perhaps not), a couple of Fellows of the College objected to a brain being on the cover, taking it to be a literal depiction of psychiatry and psychiatric disorders as ‘brain disorders’. One even suggested that it ‘grossly misrepresented psychiatry, as it overlooked the importance of psychotherapy’. And so, for a couple of years, the journal cover became a canvas for the artistic interpretation of its various phenomena (see Figure 2). This also allowed for covers that reflected special events or milestones, such as the 50th anniversary and the ‘Psychiatry Ashes’.

Figure 2.

Journal Art. Images featured on the cover of the journal to reflect aspects of psychiatry.

Then, for educational purposes, I used the journal cover to tell the story of diagnosing and managing bipolar disorder. Using cartoons inspired by comic book characters drawn in the style of Lichtenstein, the short series highlighted a number of issues close to my heart, namely, the misdiagnosis of bipolar disorder and the underutilisation of lithium. This too was another popular series, but once again, and perhaps even more surprisingly, it managed to upset those prone to over-interpretation and those who have chosen to practise a simulacrum of psychiatry (see Figure 3).

Figure 3.

The ACE Model from the Bipolar Series. Cartoon featured on the cover of the journal as part of a series illustrating the diagnosis and management of bipolar disorder (Malhi et al., 2018).

All the things that ‘doctors use’ – many scripts for you to choose

The proliferation in types of media, and in particular social media platforms, clearly signals that not only do we like to communicate involving both absorbing and broadcasting information, but that we have a basic need to do so. And hence we pursue this endeavour in as many different ways as possible, ranging from sending emojis and texting short phrases, through to uploading images and short video clips and indeed everything in between. Similarly, while the purpose of the journal is to provide a window on what is happening in psychiatry, it does so now via a variety of article types. This was certainly not the case when I assumed the role of Editor. At that time, the journal mainly published research articles and reviews, with occasional letters and book reviews. Editorials were rare and the many kinds of articles that have been introduced over the years simply did not exist. Each new type of article has been introduced because it serves a particular purpose. And together the different kinds of articles are now able to communicate a range of messages with varying impact (see Figure 4).

Figure 4.

ANZJP Timeline 2011–2021. Blue: Growth of the Editorial Team and Editorial Board. Red: Developments in publishing format. Green: Introduction of new article types.

For example, for the entry-level academic and the uninitiated, Letters are a good place to start. These are generally short, and to the point, and usually convey a simple message that relates to an article that has already been published in the journal. In comparison with letters, Commentaries are usually twice as long and allow a slightly more in-depth discussion. Again, they usually address a single point, or two at most, and like letters often expand upon articles that have already appeared in the journal. However, Commentaries also featured series such as the ‘DSM Digest’ and ‘ICD Insights’ that examined and critiqued taxonomic creations.

For those more versed in academic writing, and wishing to engage a subject matter more deeply, Debates and Editorials provide greater scope. Editorials have generally attempted to provide a balanced overview, whereas Debates are usually more contentious and are able to offer a particular perspective. However, these formats were still thought to be relatively short and limited, in terms of both word count and references, and so Viewpoints were introduced to allow more in-depth discussion of specific topics. And while everything in the journal is grounded in research, these articles have created an essential space for opinion and thoughts.

Throughout my training as a junior doctor in large teaching hospitals in the United Kingdom, there was always a junior doctor’s common room. Consultants had their own mess, and this separation allowed clinicians at different levels of experience to share their grievances openly and have confidential discussions about their day-to-day woes. I have always regarded some of the new sections of the ANZJP in this light. They allow people to express their concerns and have frank exchanges of opinion and views. And they have undoubtedly been instrumental in the success of the ANZJP and are likely to play a vital role in the development of our field. This then leaves the bread and butter of our craft and indeed the journal, namely, original research articles and reviews.

Interestingly, it took quite a while (and much longer than I anticipated) for the various types of articles to be adopted. But once the format became familiar, it was these additional kinds of articles and means of communication that provided some of the most interesting and thought-provoking discussions within the pages of the journal.

Other things

With a heavy heart

The Editor’s role itself is not that difficult, provided of course one has the necessary time and is willing to devote this to the cause. But in addition, it is essential that one has a certain skillset and can recruit others to compensate for one’s deficiencies. Indeed, the essence of the role, which entails reading and reviewing papers, providing guidance and feedback to authors, mentoring junior researchers and academics, and remaining at the forefront of ideas and discoveries, is endlessly exciting, fulfilling and intrinsically satisfying. And these aspects of being Editor I will surely miss, although I feel I have certainly had my fair share.

No, the role is challenging because of the difficult and time-consuming part, which involves dealing with the problems that various people create. The majority of these problems occur because individuals either do not understand the various procedures involved in manuscript preparation and submission for publication, or they feel that they do not apply to them, and in Australia at least, there seems to be a disproportionate number of people who feel they are in a category of their own! However, the problems created by those who simply are not aware of these issues or have not taken the time to familiarise themselves with the publishing process are fairly straightforward to deal with, but can at times entail extensive hand-holding and step-by-step education. This is acceptable, to a degree, for instance, where it involves junior academics or those embarking upon a career in psychiatry, and perhaps also for those trying to ensure their paper is the best that it can be. However, it is less acceptable, and arguably borders on rudeness, when individuals are simply being lazy. Fortunately, this does not happen very often.

The real challenge is contending with those ‘truly unique’ individuals who have an unfathomable sense of entitlement. Invariably, these individuals see themselves as special and usually betray their extraordinary point of view by the manner in which they describe themselves and their work. For example, when referencing their achievements, they refer to themselves as ‘global pioneers’ and aggrandise themselves further by name-dropping or alluding to ‘casual discussions’ they have had with ‘government members’. Over the years, I have found that conversations that begin with references such as these seldom end well. And in my experience, individuals making these claims would be much better off if they simply contested the opinions of the reviewers of their papers by mounting a logical argument rather than pleading for special consideration. The important point here, and one that is perhaps easy to overlook, is that by design, the journal provides a space for healthy debate, and that correspondence with reviewers is in fact intended to be a constructive exchange that is aimed at distilling what is important and improving the paper if it is to be published. Alas, some people are unable to grasp this simple concept.

Another key difficulty of being Editor, and especially of a journal that represents the values of a College, is that the Editor is necessarily somewhat limited in terms of what they can say. There is no formal guide per se as to what can and cannot be said or how to conduct oneself, but clearly and understandably there is an expectation, and this has to be met. Personally, I have no qualms about this, and as Editor, I have always upheld the values of the College. But now that I am stepping down, I think that it is important to point out the appalling manner in which some very senior antipodean academics, who also happen to be College Fellows, choose to conduct themselves. I can only imagine that the glare of their own self-importance blinds them to such an extent that they are no longer able to engage common sense nor, it would seem, observe common decency. In response to their blatant self-aggrandisement and puerile behaviour, one could take pity and feel sorry for these individuals. After all, it is a parlous state of affairs to have such marked diminution of self-awareness, or as a colleague of mine described it – ‘dimming of one’s reflective light bulb’. But given the nature of the emails I have received over the years, and the rather aggressive conversations I have endured via telephone – the content of which cannot be repeated in a journal of any repute, I feel obliged to deliver some form of rebuke. Suffice to say, this has been the most disappointing aspect of my role. Sadly, it has led me to lose respect for some individuals who are otherwise no doubt very talented and whom I genuinely admired at one time or another. Much of this abuse and associated nonsense, I have simply ignored and tolerated as part of my Editor’s responsibilities. And thankfully, with support from my editorial team, we have always ensured that the reputation of the journal as a fair and objective purveyor of the truth has remained intact and indeed wholly untainted (Malhi, 2019).

At the same time, I am especially proud of the fact that during my tenure the journal has never shied away from publishing an article simply because someone has voiced an objection. Usually in such cases I have asked those who have raised concerns to put their concerns in writing and ideally submit a commentary or letter to the journal. In contrast to the previous point, this is perhaps one of the most important and fulfilling aspects of being an Editor. As the Editor, I have always actively chosen to use the influence of the journal to shine a light on problems within the field, be it in research or clinical practice, and to challenge ideas and thinking, no matter who espoused them, be it an individual, a committee or an organisation (Malhi, 2016). Throughout my Editorship, I have firmly held that it is important for the journal to strive for the best standards in science, publishing, ethics and the provision of care. Hence, it has become one of the key distinguishing features of the ANZJP. (See Box 1)

Box 1.

• ‘The ANZJP!

• If we see a bear, we poke it,

• If we see a fire, we stoke it,

• If we see a turkey, we choke it.

• The ANZJP!’ (Malhi, 2016)

Light-hearted remarks

Not wanting to conclude my jaunt down memory lane on a sombre note, I thought it would be entertaining and simultaneously instructive to include some of the more absurd and whimsical interactions I have had as Editor, especially as most people are unaware of this aspect of the Editorial role. While the journal no doubt demands many hours of work, I have also found it to be a constant source of amusement. For instance, correspondence with authors and reviewers has been a fertile source for comical miscommunications and misunderstandings, and so I have grouped some examples according to the sender. Of course, no names have been included, but I can supply them upon request! ¹ (Not).

Cover letters

Cover letters usually touch on the highlights of a paper and draw the attention of the Editor to the importance of the research findings being submitted for publication. In the case of other types of articles, such as Debates and Editorials, the author may use the cover letter to reason or provide some explanation as to why they hold a particular view.

Excerpt 1, sent as an email:

I have submitted a letter to the editor, and have addressed it to you, but I haven’t used your name, I have simply said ‘to the editor’, I hope this is not confusing. And so, I thought I might write to you directly to explain my thinking. I was not sure if letters go directly to the editor, and if so, which editor, and so the letter is simply ‘to the editor’. I hope that this is ok and that this does not cause any confusion. If however this is confusing, and if you are not the editor, can you please let me know whom to contact and whether I need to explain this to them as well. By the way, my letter is excellent. Please publish it.

Excerpt 2:

Dear editor, please give full consideration to our paper. We are aware that it is not formatted according to the journal and that you require a structured abstract and Harvard style of referencing. However, this paper has been rejected by several other journals and we have had to modify the paper each time without success. Therefore, we would appreciate it if it can be reviewed as is. Also, note one journal did review our paper but only provided one review and we have not modified our paper because we did not agree with the feedback. Please review the paper, we think it is a perfect fit for the American Journal of Psychiatry and will be of great interest to readers in North America and across the world.

Correspondence from authors upon rejection

Excerpt 1:

Dear editor,

We are very disappointed that you have rejected our paper without sending it for review. The paper has been rejected by journals with higher impact factor than your journal and each time they have provided reviews.

Excerpt 2:

Dear editor,

We have revised this paper to the satisfaction of the reviewer on three occasions. However, on each occasion, in addition to accepting our changes the reviewer has made additional requests pertaining to the other parts of the paper. Would it be possible to ask the reviewer to put all their requests at the same time in one document, so that we can address all the concerns in one revision, as the process of revising and uploading different versions is both time consuming and confusing.

Note: the paper underwent one further revision and was then accepted.

Excerpt 3:

Dear Editor,

We submitted our perspective piece, having been encouraged to do so by one of the associate editors. Unfortunately, it seems that you were not aware of this, and so it was rejected without review. We then received an invitation from yourself to resubmit the article, and we did so, giving consideration to a few points you made in your email. However, now we learn that it has once again been rejected without review. While we are able to handle rejection, we fail to understand the purpose of being invited only to be rejected!

Explanation: When first submitted, the associate editor had not communicated to me that they had asked the authors to submit to the ANZJP, and so upon reading the article I thought that it was not particularly well-written and the topic did not appear to be critical. Upon resubmission, the authors had bolstered their arguments and strengthened the paper, and so this time, I assigned the article to the associate editor who had encouraged them to submit. Normally, at this point, the article would be sent for review by the associate editor. However, at this juncture, it was the associate editor who felt that the paper was not up to scratch, and therefore recommended rejection. This is one of the risks of inviting authors to write and submit to the journal. Sometimes the standard of what is submitted when articles are ‘commissioned’ leaves much to be desired, perhaps because authors feel they do not have to try very hard.

Queries regarding submission

. Dear editor, we submitted our paper titled XX more than 6 months ago, and now cannot find it on the submission website. Can you please update us on its progress, and if you have decided not to publish our work, then at least let us know!

Note: we conducted a search for the name of the author and the title of the paper, and we too could not locate it. We therefore asked the authors for its identification number, as all papers once submitted to the ANZJP acquire an identification number that begins with ANP. However, when the authors responded, it became clear that they had submitted the paper to another journal, not the ANZJP! I therefore wrote to the authors:

Dear XX, The ANZJP is always happy to consider your work, especially original research, however in order to do this, as a minimum, we do require that you submit your paper for our consideration. Otherwise, as you can imagine, it is exceedingly difficult for us to offer an opinion.

Concluding remarks

I had never imagined that I would one day be the Editor of the ANZJP. This is because, having trained in the United Kingdom, I thought I would most likely remain in Britain, and that if I did pursue a career overseas it would be somewhere in North America. Therefore, when I came to Australia, somewhat by chance, equipped with full membership of the Royal College of Psychiatrists, extensive training from the Cambridge psychiatry clinical rotation, specialist experience in mood disorders from the Bethlem and Maudsley hospitals, and burgeoning academic skills acquired as a Clinical Lecturer at the Institute of Psychiatry, I was more than somewhat puzzled when the College (Royal Australian and New Zealand College of Psychiatrists [RANZCP]) decided that I needed to undertake further examinations! To add insult to injury, the exams were not limited to psychiatry, and in fact included the general medical examination that was in place at the time. Undeterred, I did the exams and chose to remain within academia. Some years later when the opportunity arose, this enforced qualification allowed me to assume the role of Editor. Upon reflection, I am grateful that the College insisted that I become a Fellow because without the Fellowship I would not have been eligible to lead this journal. It has been an honour and true privilege to serve as Editor and play a role in defining the impact of the ANZJP on the world stage. And despite the demands, the role has been an immensely enriching experience – for which I am sincerely grateful.

Professor Gurjhinder Singh Malhi,

BSc(Hons), MBChB(Manc), MSt(Oxf), MD(UNSW), FRC Psych, FRANZCP

Editor, ANZJP