Dying Declaration: Musings from the Outgoing Editor

“We forget things if there’s nobody to tell them.” - The Lunchbox (2013 Hindi movie)

This is the final issue of the journal featuring my name as the editor, and here is my first solo editorial in these six years. It is going to be personal, pompous, and long. You’re warned!

The Fortuitous Journey to this Post

Coming from a family of medical journal editors, growing up watching them send the manuscripts for peer review through snail mail, helping them seal the envelopes, paste the stamps and all, it was natural for me to aspire to be and eventually become one… Well, not quite! I am still the only doctor in our extended family, and the stamps I pasted were on the poems and stories with which I used to bombard Malayalam children’s magazines.

My first tryst with medical journals happened in the undergraduate days when I mentioned one in a short story, for a college magazine, about a medical student who tries to write a poem but struggles with writer’s block created by academic pressure and urban, apartment life. When he tells his lover he has a distaste for veins because of the way they bulge on beautiful bodies like hers, “as on the pinnae of goats,” she replies that on seeing a vein, he should think of a recent Lancet article on deep vein thrombosis, instead. Well, I was merely name-dropping then—I had never seen any journal.

It was not until my internship that I encountered one. At the Calicut Medical College library, a board at the entrance to the journal section warned visitors that entry is restricted to postgraduate students and faculty members. I was mad about Psychiatry at the time, wanted to know what a Psychiatry journal looked like, sneaked into the area one afternoon, found the Psychiatry section, and picked up the issue of the American Journal of Psychiatry on display. Flipping through its pages, I briefly wondered if it carried only advertisements. However, my eyes soon halted at an enlightening editorial by Eric Kandel titled “A new intellectual framework for Psychiatry,” ¹ which further fueled my interest in pursuing this specialty.

During my postgraduation at the Central Institute of Psychiatry (CIP), Ranchi, I had the opportunity to explore the country’s largest Psychiatry library. I remember my disappointment upon comparing the Indian Journal of Psychiatry (IJP) to other journals; it appeared pale and lacking in professionalism (it was before Medknow took over). On the other hand, I found Current Psychiatry, edited by Henry A. Nasrallah, awe-inspiring. Unlike other journals, it was highly readable, employing simple language and incorporating numerous photographs and illustrations, and looked more like Outlook and India Today than fellow journals. I wished all journals could provide such a smooth and enjoyable reading experience. I even attempted an intervention along those lines: like most of my peers, I too found Fish’s Clinical Psychopathology impenetrable (“Fish is fishy”, one of my seniors used to quip). I “edited” the book into one I can understand, handpicking and highlighting essential portions and arranging them in a more accessible format. I distributed copies of this modified version to fellow students, who found it helpful.

Months later, during a trip home, a classmate from pre-degree who was doing engineering introduced me to website designing. I got hooked instantly and soon created a website on the free GeoCities platform. The internet has been gradually becoming popular in India, and my website, which contained links to important Psychiatry resources and treatment guidelines, gained some appreciation from senior psychiatrists. In 2003, immediately after my MD exams, I registered the domain www.psyplexus.com and developed what I believe was the first Indian portal on mental health. In the process, I read a lot about managing and promoting websites. I also attended the first workshop in the country on open access, organized at the MS Swaminathan Foundation, Chennai ² —I was the sole medical doctor among the participants. Motivated by this experience, I created an open-access toolbar for Internet Explorer, which garnered some international attention.^3,4 I also came across Open Journal Systems (OJS), the free platform to run journals. In the CIP Library, I had been impressed by Neurocase, a journal dedicated to case reports in Neurology, which inspired the idea of creating a similar journal for Psychiatry. I shared the plan with two batchmates, who promptly joined me. We acquired the domain www.psychreports.org, I installed OJS in it, and we launched a journal, christened Psychiatry Reports. However, our enthusiasm soon waned, and we abandoned the mission after publishing 2–3 case reports.

Unlike some of my contemporaries at the Institute, I had not been active in research or publishing, though. By the time I left Ranchi in 2006 after my senior residency, I had two case reports in international journals as the first author. The research paper based on my MD thesis had been rejected by two prominent journals, giving me a taste of the peer review process.

After senior residency, I decided to revisit my previous interest in fiction writing—this time, screenwriting. I devoured tons of material on its craft and wrote three screenplays over the course of four years. I even produced and directed the second one, a 70-min film ⁵ on a non-believer’s coming-out struggles in a religious dystopia. The third one, titled “God of Dreams”, about a narcissistic poet who, disheartened by not getting the recognition he felt he deserved, turns to cannabis addiction, develops a delusion that he is the one who transmits dreams to everyone’s minds, and subsequently, “fails even as a mad man.” ⁶ Although it won the Best Screenplay prize from the Kerala state branch of Indian Medical Association in 2012, it failed to impress the film directors with whom I managed to share it.

Although one of the reasons I chose Psychiatry was to leverage my writing experience to raise awareness about mental health, I had taken no significant steps in that direction even after 5–6 years since obtaining my MD. Realizing that the kind of screenplays I write is unlikely to find a market, and with a home loan to repay and the necessity of building a patient base, I decided to start writing Malayalam articles on psychiatric topics. The first one I submitted, about the genetics of alcoholism, got published in the leading health magazine in the language. Subsequently, that and other magazines started requesting me for articles, and in the following years, I have written about 200 of them (www.mind.in), including a monthly column on cyberpsychology that ran for 3.5 years. In the process, I extensively studied the art and craft of writing, particularly science writing, including techniques for editing one’s own work. (Numerous tips and techniques on popular science writing will be shared in my chapter on print media and mental health awareness in the upcoming Indian Psychiatric Society [IPS] clinical practice guidelines on mental health and well-being).

In 2012, I created www.manasikarogyam.com, a public education website featuring many Malayalam articles and videos by psychiatrists, for the Kerala state branch of the IPS. Later that year, during the organization’s Annual General Meeting, Dr VK Radhakrishnan proposed my name to the Executive Committee. Simultaneously, Dr Thomas John became the editor of the Kerala Journal of Psychiatry (KJP) and chose me as one of the two assistant editors. The journal did not have a peer review system then, and I was the sole reviewer and copy editor for all articles published in those two years. In 2014, when the time came to elect the next editor, Dr Jayaprakashan KP urged me to submit a nomination. I was hesitant, mainly because by then I was busy with the Malayalam articles. However, he insisted (“You shouldn’t complain if someone without any knowledge of research or publishing takes up the post and ruins the journal”), and I eventually obliged.

With my experience from a decade ago installing OJS for Psychiatry Reports, I created a website for KJP with OJS. I also achieved some basic requirements such as ISSN (International Standard Serial Number) and eISSN. One significant need was establishing a peer review system. Probably a first for a Psychiatry journal in the country, in 2015, we organized a one-day workshop for reviewers.^7,8 Apart from the technical skills required to manage the website, the major areas in which I was able to contribute were editing and restructuring the articles, which came from my self-study and experience in screenwriting and science writing (“You shouldn’t allow an idea or even a word to enter your script without giving it a third degree”, had advised a screenwriting guru). Nevertheless, my proficiency in research methodology and statistics was limited (“Wherever a mean is mentioned, you should insist on standard deviation, too,” said Dr Samir Kumar Praharaj after going through an issue.) Eventually, in 2017, I received a phone call: Dr MS Reddy would not contest for the post of the South Zone editor this time and I should submit a nomination. I won the election by a narrow margin, hugely helped by sheer luck—in-person voting at the annual conference had not been amended out yet and the conference took place in Kerala, which happens once every five years!

Time to Roll the Credits

A major initial challenge I had to overcome was my lack of research expertise and experience. Knowledge of Oxford comma, misplaced modifiers, parallel lists, and so on, is not enough to edit a journal included in PubMed and Scopus; one must also know about interquartile range, unadjusted odds ratios, Cronbach’s alpha, triangulation, and the like. Hence, I chose two well-published researchers—Drs. Samir Kumar Praharaj and Vikas Menon—as my advisers in matters of research methodology and statistics and soon christened them Chief Associate Editors. (Samir, a best friend from the postgraduation years, was once scoffed by an ignoramus job interviewer, “Hundreds of publications you’ve. Do you ever see patients?!” Most I had seen of Vikas before was on conference stages, collecting all sorts of research awards and making dazzling presentations.) All research papers accepted during our tenure were assessed by Samir in an additional stage of post-peer-review editorial review. Vikas assisted in the initial assessment of submissions, particularly original research, and offered further comments to help me make decisions in case of mixed reviews. (The changes we introduced in the journal, initially and while transitioning to the current publisher, were detailed earlier.^9,10 We also conducted a few journalology studies about this journal’s functioning, which helped us fine-tune our own processes).^11–14

Most of the improvements this team could bring to the journal were built upon the solid foundation established by the previous editor, Dr MS Reddy, who had secured the journal inclusion in PubMed and Scopus, among other things.

Although finding good peer reviewers has become a challenge for journal editors across all fields, we never faced such trouble. From broad psychiatry topics to focused ones such as machine learning and transcranial direct current stimulation, this journal had quite a few knowledgeable and altruistic reviewers who consistently provided constructive feedback within the designated timeframe.

Members of the e-Journal Club India group (https://groups.google.com/g/eJCIndia) have been quick and efficient in picking holes in the research papers this and other journals publish. ¹⁵ One of the motives for us to make our articles as error-free as possible was the desire to not become their next game!

This journal charges neither the authors nor the readers; our primary means to meet the expenses has been advertisements. In this period, Drs. Jagadish A, Mahesh Gowda, Kishan Porandla, and especially K Ramakrishnan secured enough advertisements for us. Without them, we would have been forced to resort to self-publishing or collecting article processing charges. Noteworthily, despite supplying the funds, none of them attempted to interfere with editorial freedom.

When I first assumed the role of editor, no restrictions were in place regarding the maximum duration for which one could hold the post. My predecessor had served for 12 years, and as such, I too was preparing for a long innings. I purchased online numerous used books on research and other relevant subjects and managed to read some of them. However, the South Zone constitution was subsequently amended, specifying a maximum term of six years for editors. I perceive that as a blessing in disguise. I initially accepted the position out of a sense of responsibility, but now I can step down without any lingering guilt and pursue my other areas of interest before age or ill health hinders me. Thanks to the arbitrators of the amendment and all the members of the South Zone for the same.

The current publisher, Sage, has been highly supportive, agreeing to use the page design we proposed, allowing distinct cover images for each issue, and so on. Himani Raghav, the current Production Editor, has been very prompt and efficient.

Abhilash Chacko, who redesigned our pages when we moved to Sage and created most of our covers, helped enhance the journal’s visual appeal and readability.

Authors of Diverse Sorts

We did not encounter or catch many instances of unethical practices by authors. The most common problem was splicing, which we also systematically studied. ¹⁴ In one instance, a co-author submitted the manuscript elsewhere without the knowledge of the corresponding author in this journal; it was accepted by both journals and finally published by the other, much smaller, journal. Another article was withdrawn by the authors when it was in the editorial review stage and on the verge of acceptance; later, I saw it published in a predatory journal!

Counterintuitively, being a journal editor also provides some lighter moments. One submission described an author’s affiliation as “wife of HOD.” When I responded to a pre-submission inquiry that the manuscript might not survive peer review, the author replied, “Maybe I’m too good for your journal” (and I would call such behaviors “authoritarianisms!”). When a reviewer queried an author about the considerable delay between data collection and manuscript submission, the reply received was “destiny.” One team submitted an author contribution grid where all cells were ticked for all authors, indicating that even the most senior author, who was also the Dean of the institution, had contributed to all areas of the study, including collecting data from the patients.

Suggestions for Budding Editors

I was allowed to contribute some of my thoughts to the recent consensus statement by editors of Psychiatry journals published in India. ¹⁶ I had also written about the duties of a journal editor. ¹⁷ Box S1 has a list of helpful books I strongly recommend.

India still faces a shortage of high-quality mental health journals. ¹⁸ I request editors of smaller journals not to compromise on standards in an urge to fill pages. Some flexibility may be allowed in novelty but not in the strength of the methods or the quality of the writing. Adequacy of reporting can be ensured by mandating the submission of reporting checklists as supplementary files. All submissions should undergo rigorous peer review. Consequently (let’s hope!), with time, the authors would stop expecting anything with the IMRAD structure, some tables, and p values to find a place in a journal and instead start being diligent from the protocol-writing stage itself. (In my experience, once you consistently dare to reject subpar articles from influential individuals and disregard recommendation calls about manuscripts under consideration, the news of your impartiality will likely spread and expectations of favoritism will eventually dissipate.)

Peer reviewers play a crucial role in ensuring the quality of a journal. Methods I used here to thank them in small ways include providing digital certificates; allowing the reviewers of a manuscript the option to see each other’s comments; sharing resources on peer review and some inside info on the journal, such as the theme and cover of the upcoming issue and detailed metrics reports, with them through a WhatsApp group; and allowing a slightly higher threshold during desk-rejection decisions. Exceptional reviewers were promoted to the editorial team. Assigning three reviewers to each article ensures that even if one is unable to submit the review on time, the editors can proceed with the available reviews.

Before seeking or accepting any help, for the journal or even personal purposes, consider the possibility that the person may submit an article anytime soon, leading to a situation of conflict of interest. (While returning after presenting a one-day workshop on academic writing and enjoying commendable hospitality, when I woke up on the train the following morning, the email app informed me that the key organizer of the workshop has made a submission!)

In the past five years, our CiteScore and Journal Citation Indicator (Figures 1a and 1b) had shown a gratifying upward trend. (Though, as always, correlation does not imply causation, in these very years, my hairline had receded at a surprisingly similar rate!) This year the journal also got its first-ever Impact Factor (IF); that too a 2.8, not common for an Indian medical journal, and equal to that of Alcohol and Alcoholism. However, it is essential to emphasize that, as stated previously, metrics have never been our primary priority. ¹⁰ Our goal, which guided all our decisions, has always been to provide readers with the most informative and valuable content. Any improvements in metrics have been a byproduct. I hope that other editors will also adopt a similar policy. Though the rejection report of our MEDLINE application suggested to “include more international authorship,” I request the incoming editor to consider it only if the article would interest clinicians, researchers, or policymakers in India and not merely to impress MEDLINE.

Figure 1a.

Source: Scopus.

Figure 1b.

Journal Citation Indicator of the Journal in the Last Five Years.

Many have asked how I manage to find time to run the journal. However, my ways may not be generalizable. (During post-graduation years, my batch-mates had diagnosed me with schizotypal disorder!) From Monday to Saturday, I am busy as a clinician till evening. I am a morning person and do most of the intellectually demanding tasks—copyediting and peer review of all accepted articles, for example—during the morning hours. In the evenings, while physically and cognitively exhausted, I finish the less demanding chores such as replying to emails, granting deadline extensions, initial evaluation of easier submissions, and using language-checking software on accepted submissions. I do not spend time for religious rituals, rarely visit friends and relatives or attend social functions, stopped following cricket at a time when Vinod Kambli used to be on the crease, and after reading an impressive book, ¹⁹ discontinued watching news channels. All this meant, even after spending time for the journal and to read books that helped improve my editorial skills, I had enough time left to not only occasionally make academic presentations or write Malayalam articles but also pursue my passion for photography (Figure 2), read extensively about its artistic and technical aspects, and watch my kind of movies.

Figure 2.

Photo Taken by the Author, on the Cover of the March 2023 Issue of the Journal.

Editing a journal requires knowledge in diverse areas, including statistics, research methods, peer review, scientific writing, grammar, rhetoric, and ethical, legal, and technological aspects of publishing, among others. To be efficient, editors must continuously learn about such domains. Moreover, it is pretty easy to fall victim to the Dunning-Kruger effect—though a MEDLINE reviewer commented about this journal that the “writing is clear, concise, and logical, and language does not impede scientific meaning,” my confidence in my ability to edit my own and others’ text suffered a blow upon witnessing the improvements ChatGPT made to this write-up!

In a book on editing, the author ponders which lesson he learnt during his tenure could have benefited him the most had he known it when he started. My answer to this is not to harbor excessive expectations about publishers. While doing all-round work for KJP (including typesetting the pages and carrying loads of print copies to conferences for distribution), I had a notion that had there been a professional publisher, my job would have been much easier. While publishers indeed facilitate numerous aspects of the process, the editor must still remain very vigilant.

Periodically, revise the journal policies, review the editorial team, refine and expand the pool of peer reviewers, and organize training programs for them. Occasionally submitting your own manuscripts to other journals can help improve your empathy for authors who submit to your journal. Even if the publisher provides copy-editing services, do one round of copy-editing on your own because unlike you, the professional editors may not have subject expertise. Those serving as handling editors or hoping to be one should not miss the editorial Vikas has written in this issue. ²⁰

Some Tips for Authors

To increase the chances of publishing in reputed journals, it is crucial to ensure from the outset that your study is sufficiently novel, contributes significantly to the field, and is methodologically sound. In India, most submissions originate from theses and dissertations, ¹⁴ and worthy topics may not be easy for a first-year student to identify. Therefore, the guidance of teachers, especially junior faculty members, is vital, and they should strive to maintain the necessary expertise. (For the senior faculty members burdened with clinical, teaching, and administrative responsibilities, research in the department may be a sideshow, and finding novel topics, keeping themselves updated about the developments in the publishing field, training and hand-holding the students in research-related matters, and so on may be, as Lawrence describes the Arabian Desert campaign of world war I in Lawrence of Arabia, “sideshow of a sideshow.”) Collaborating with academically-oriented clinicians can help identify novel topics, as good research ideas often stem from unanswered questions in daily practice. (For example, when considering discontinuing disulfiram, I have often wondered whether providing the patient and family with a strip of tablets to restart after 24 hours of a lapse would be effective, and if not, why.) Choosing topics that are entirely new to the field, such as the Mental Healthcare Act 2017 during its initial implementation or the COVID-19 pandemic at its onset, can also be advantageous. Remember that journals may assign less importance to studies conducted on medical, dental, nursing, or paramedical students compared to those involving patients or the general public.

Avoid basic errors such as failing to obtain approval from an Institutional Ethics Committee or to register intervention studies in a trial registry, not performing sample size calculation, and collecting variables such as age and duration of illness as categorical instead of continuous. Refrain from the prevalent practice of applying a concoction of scales and performing exploratory item-by-item comparisons in the hopes of finding some p-values below the magical threshold of 0.05 somewhere. Instead, depend on one primary and 1–3 secondary objectives, all rooted in solid theoretical foundations.

Numerous grant opportunities are available today, including the thesis-study grants the IPS has started. Take advantage of such options. My experience is that most authors do not thoroughly read the instructions to authors or, dismayingly, even the directions provided in email communications. This leads to wasted time and effort for editors and authors alike. Before submitting to a journal, go through some of its recently published articles to ensure that your manuscript matches their novelty and methodological rigor. Otherwise, it may face a desk rejection—although that aids the journals to boast of a higher rejection rate, better submit to a more appropriate journal to save time and to avoid the disappointment of an immediate rejection. As the peer review always takes time and the editors cannot expedite it even if they want to, it is best to prepare your manuscript and initiate the submission process as early as possible. Cultivate a habit of expressing gratitude to peer reviewers and editors for their contributions because they volunteer their time to help improve your article. The sad reality that most Psychiatry postgraduate departments in the country do not subscribe to this journal or IJP should urgently change.

For novice researchers, I recommend the “Primer” book published by IPS, ²¹ of which I am a co-editor, and the Learning Curve column Dr Chittaranjan Andrade writes in this journal. Joining the e-Journal Club India group would be beneficial, too. I had posted some videos on a YouTube channel (https://www.youtube.com/@ResearchWorkshop), which, by the way, I had to discontinue due to poor audience response. The editorial Samir has written in this issue, too, has several great tips. ²²

Young faculty members, in particular, should consider becoming peer reviewers in journals published from India. That would not only improve critical thinking and academic writing skills but also help foster good relationships with journals. Good, free online courses on peer review are available from Nature (https://masterclasses.nature.com/focus-on-peer-review-online-course/16605550), Cochrane (https://eyes.cochrane.org/free-online-course-journal-peer-review), and Clarivate (https://webofscienceacademy.clarivate.com/learn/public/catalog/view/23).

Regrettably, many who are active as researchers and peer reviewers have not become Fellows (with voting rights), or even members, of professional organizations such as IPS. This must change; they should become more involved and assume important positions in various organizations.

Requests to Professional Organizations

In the past few years, we have witnessed several positive developments such as the multi-centric studies by the IPS, the recent establishment of the IPS Academy, the formation of an IPS subcommittee for international research collaboration, the recent meeting of many editors of Indian journals on Psychiatry and the publication of a joint statement, organization of peer review workshops during national events, probably for the first time, in the Young Psychiatrists and mid-year conferences this year, the Brief Course in Psychiatric Research organized by the Research Capacity Building Committee of the South Zone running successfully for the third consecutive year, two Indian journals on Psychiatry achieving Scopus Q2 status and an IF around 3, and so on. Nevertheless, several areas still exist in which we can improve.

I request the IPS, its zonal and state branches, and other psychiatric organizations in the country to reconsider the process of electing editors through a vote by all members. For editors planning to get re-elected, rejecting manuscripts from influential members may be hard. (“Two of us just voted for you, and we are now submitting an article” was a phone call I received.) It is an unpleasant experience to make campaign calls to voters whose submissions you have rejected. Moreover, individuals with expertise in research and publishing may not possess the necessary skills to win elections. Following the example of organizations such as the Royal College of Psychiatrists, we too can adopt a selection process involving the aspirants submitting their CVs and their plans for the journal, followed by an interview. Till such fundamental modifications can be implemented, it would be advantageous to at least insist that contestants for the editor post have some research and publishing experience, as the South Zone currently does.

The zonal and state journals must be strengthened further. They can play a vital role by providing a platform for newcomers to learn the basics of the publishing process. Younger researchers can gain valuable experience by submitting to, getting peer-reviewed by, and publishing in smaller journals. The more prominent journals can then focus on studies and other articles that can influence policymaking and clinical practice, for example. For instance, state journals can publish studies examining the prevalence of stress, burden, burnout, and so on, while the larger journals can have studies evaluating interventions for such problems. (As IJP and IJPM have achieved good-enough IF, many papers that would have otherwise been submitted to international journals might now be redirected to these. This, in turn, necessitates the presence of sufficiently good alternate journals to publish the kind of papers we have been accepting so far.)

Organizations should recognize and reward junior faculty members interested in research. Awards distributed at the annual conferences currently serve as a major method for identifying and encouraging the best researchers. Therefore, the criteria for selecting the award winners should be as objective as possible. ²³ When selecting speakers for scientific programs, some priority may be given to active peer reviewers of your journal, provided they possess the necessary presentation skills.

In their criteria for promotion, the National Medical Council now considers systematic reviews equivalent to research articles. Organizing workshops on performing and preparing one can help those in teaching positions, especially in smaller centers, secure promotions by publishing them in leading journals instead of paying predatory journals to publish low-quality research papers as some currently do.

Although training on research methodology and statistics occasionally happens, that on the craft of writing is scarce. Consequently, editors (and in journals that do not have any copyediting, readers too) are often forced to waddle through articles that remind of what Joe Gillis remarked about Norma Desmond’s screenplay in Sunset Blvd., “Sometimes it’s interesting to see just how bad bad writing can be.” Programs on drafting the various components of the IMRAD structure, as well as using English with correctness and clarity, are highly needed.

Some Insuppressible Closing Questions

I remember reading about a retiring journal editor who pondered whether, if he had rejected all the articles he chose to publish and instead published an equal number of articles from his rejection pile, would it have made any difference to his field. Many such queries spring into my mind too. On those evenings in which many were watching the Indian Premier League, binging on an online series, or engaged in private/online practice, I was busy verifying patient consent in case reports or deliberating whether the time was appropriate to send a reminder or assign another article to a particular reviewer or such. Was it all worth it? Did the time and effort we invested make a significant impact anywhere? Did any of the authors carefully review the stylistic changes I made to their accepted manuscripts, learn something from them, and apply those insights in their subsequent articles or pass them on to their students? Did the fact that IJPM gave a lot of space and importance to viewpoint articles, even those with slightly quirky propositions, inspire any of our readers to explore their own fleeting notions, organize the results, and submit them to the journal? Did some of the papers we meticulously curated and published contain falsified or fabricated data? Did any rejections discourage aspiring researchers, leading them to give up? Extrapolating from Mahatma Gandhi’s words, “Recall the face of the poorest and weakest man you have seen, and ask yourself if this step you contemplate is going to be any use to him,” did our travails truly benefit any individual living with mental illness in India? As Kamal Haasan, at the end of the Tamil movie Nayakan, in which he played the role of a cruel don who at the same time was helpful to the poor, replies when his grandson probes whether he is a good person or bad, “I don’t know.”

Supplemental Material

Supplemental material for this editorial is available online.