The BJPsych: from asylum to psychiatry by dint of mental science

Summary

After thanking his predecessors, the newly appointed College Editor and Editor-in-Chief of The British Journal of Psychiatry, Professor Gin Malhi, outlines both the historical and personal significance of the journal in this proemial editorial.

It is customary for incoming journal editors to write a brief note of thanks to those that have gone before them and then set out their stall. In any such missive, before outlining one's new initiatives there is usually a brief mention of anticipated challenges, for example those facing publishing or the subject matter of the journal and its functioning. This is a tried and tested formula and one that I am not inclined to tinker with, not least because thanking one's predecessors is an integral part of the ceremony of passing the ‘editorial baton’. Thus, such recognition needs to be proper, especially when justified. Besides, on this occasion, it also happens to be an absolute pleasure.

It is all the more straightforward for me to express my gratitude to previous BJPsych editors, in particular the two most recent incumbents (Professors Peter Tyrer and Kamaldeep Bhui), because between them they have skilfully captained the journal over the past two decades and positioned it favourably among its competitors. However, the fact that the journal has been managed adroitly should come as no surprise as they are both not only distinguished Fellows of the RCPsych but also accomplished editors. In Peter's case this is evidenced by the fact that, despite stepping down from his role a decade ago, he continues to write and edit. In fact, only recently, I contributed a chapter to his forthcoming textbook (Making Sense of the ICD-11: For Mental Health Professionals, CUP), in which he brings together incisive critique of our ailing psychiatric taxonomy. The text has been penned by those in the know and is therefore predictably polished, but because of Peter's penchant for perfection, which clearly benefitted the BJPsych when he was at its helm, it has undergone additional buffing that has added extra shine. Similarly, over the years, as our paths have crossed frequently, Kam and I have joined forces on projects, publications and pastimes. It has helped that we have several interests in common, including our enthusiasm for cricket. This is one of the reasons why I proposed the psychiatry equivalent of the Ashes when I was editor of the antipodean college journal, the ANZJP, and Kam was captaining the BJPsych. The ‘game’ managed to bring together unlikely bedfellows – academic psychiatry and cricket and the match was very much a one-sided affair. However, it provided an opportunity for me to see Kam's skills not only as a leader but as a team player – an attribute he regularly displayed as editor of the journal. Thus, I thank them both sincerely for their guardianship and advancement of the journals, in particular the BJPsych, and for their professional and personal support and friendship.

To plan for the future, it's necessary to have an appreciation of one's current circumstances and helpful to understand one's past. The history of the BJPsych is fascinating and it provides some useful insights. Therefore, after a brief and selective account of how the BJPsych came into being, I will draw on some of my personal interactions with the journal to convey why I believe it is special and has unique potential.

The asylum and mental science

The British Journal of Psychiatry (BJPsych) turned 60 this year. The first volume under this name was published in 1963, although its history extends back a further 110 years (Fig. 1). The very first volume was published in 1853 and was called The Asylum Journal, but this was modified in the very next volume and the term ‘mental science’ was added to the title. The precise reason for this is not known but it is thought to reflect ‘the broad views held by the first editor, Sir John Bucknill, on what should be in the Journal's scope and purpose’.¹ Therefore, beginning in 1855, the subsequent three volumes were called The Asylum Journal of Mental Science. However, this name also did not last and 3 years later, in 1858, the title of the journal was changed yet again, to the Journal of Mental Science, a name that it retained for more than a century.

Fig. 1 The British Journal of Psychiatry: the development of the journal title from its earliest incarnation in 1853 through to the present day.

It is noteworthy that The Asylum Journal was published not long after the forerunners of the BMJ and the American Journal of Psychiatry (Fig. 2) and that these journals also underwent a number of name changes. These mid-19th century journals were preceded by The Lancet and the New England Journal of Medicine, which emerged in the first quarter of the 19th century; however, even these time-honoured journals are relative newcomers when compared with Philosophical Transactions, which was first published in the 17th century (1665) and remains the longest-running scientific journal in the world.

Fig. 2 The development of a number of British and North American medical journals. Henry Oldenburg (1619–1677) was the first appointed secretary of the Royal Society of London and thought to be inceptor of the present-day scientific article.

a. Now known as the Royal Society.

b. the Edinburgh Medical Journal has undergone many name changes since 1733.

c. the Provincial Medical and Surgical Journal and the London Journal of Medicine combined to form the Associate Medical Journal, which later became the British Medical Journal.

d. now known as the Journal of Nervous and Mental Disease.

e. now known as the Journal of Pathology.

It is safe to assume that these publications, which have clearly stood the test of time, have important functions. Indeed, their longevity lends credence to the ideas published within their pages, as they have come to be regarded as reliable sources for academics and clinicians. As medical journals, they play a critical role in shaping clinical practice and defining the scope of medical inquiry. They also inform doctors and aid the development of standards for the profession that help preserve its reputation. In his address to the American Association of Medical Editors, of which he was president, Leartus Connor described the potential contributions of the medical journal to progress in medicine as ‘the great unifier of the past and present, the diffuser of all new facts, new thoughts [ … ] It at once gives to all that which any one person has found helpful or useful in his fight with disease and death. It enables thus the profession to move onward’.² I am equally sanguine about the role of medical journals, in particular the BJPsych, which serves a vital function in psychiatry. This is because, perhaps more so in psychiatry than other specialties, there is a burgeoning need to circumscribe the limits of our knowledge and define what is good clinical practice.

Straight out of the gate, The Asylum Journal set its sights on this superb goal. In its inaugural issue the journal reported the observations and opinions of Dr George Johnson, a physician who, on carefully examining and monitoring patients in hospital and those attending a dispensary, concluded that ‘in a certain proportion of cases, the more formidable diseases of the mind are gradually developed’ from ‘slighter derangements of the nervous system’.³ Particularly impressive, however, is his deduction from this that ‘when the nature and the origin of these nervous disorders are detected sufficiently early, the more serious forms of disease may often be prevented, and the slighter derangements entirely recovered from’. Apart from demonstrating remarkable prescience regarding modern-day concepts in psychiatry such as early intervention and prevention, he makes an admirable allusion to the possibility of cure – a goal that modern psychiatric medicine has largely lost sight of. Another term that has disappeared, but thankfully so, is ‘psychopathist’, an old-fashioned British term for psychiatrist which Dr Johnson uses in the same passage. The mention may be somewhat jarring to the modern mind because of its similarity to psychopath, but arguably it is still preferable to the outdated US term alienist.

The British Journal of Psychiatry

If there was ever any doubt about the extent to which mental science featured in the BJPsych it is readily dispelled by examining the last issue of the Journal of Mental Science and the first issue of the British Journal of Psychiatry. Both of these issues, in Volumes 108 and 109 respectively, that together signify the name change of the journal, contain an original research article examining the therapeutic effects of amitriptyline in chronic depression. There was much interest at the time in these new medications and both pairs of authors conducted double-blind placebo-controlled trials, publishing their papers in successive issues in 1962⁴ and 1963.⁵ The research showed that the new antidepressant was remarkably effective. Looking back on these studies, which are relatively small and simple by today's standards but nevertheless achieve both statistical and clinical significance, the importance of straightforward design and sensible sampling in clinical trials is suitably underscored. The inaugural issue (January, 458) of the British Journal of Psychiatry also contained an article on the ‘Treatment of manic illness with lithium carbonate’ by Ronald Maggs.⁶ In this paper the author lays out clearly the study's double-blind design and finds reassuringly that lithium is effective in the treatment of mania, which incidentally is defined eloquently as ‘an excitability of mood and movement associated with rapid, forceful thinking, in the absence of evidence of incongruity of affect’. At the same time the paper also contains a sad reminder of the enormous stigma that is associated with mental illness. It uses the term ‘mental defective’ to refer to intellectual disability, and although this term is no longer in use, we are a long way from eliminating negative attitudes towards our patients and our profession.

A personal perspective

Having completed my medical studies and subsequent training in Britain during the 1980s and 1990s, I have fond memories of the British Journal of Psychiatry, or the ‘yellow journal’ as it was often referred to at the time. I took a keen interest in the specialty while I was still a medical student at the University of Manchester, and recall dipping into the journal in preparation for my psychiatry viva. The then Head of Department Professor David Goldberg, in addition to lecturing students, conducted examinations of those passing with distinction, and it was he who inspired me to consider a career in psychiatry and possibly an academic one.

My subsequent encounters with the BJPsych occurred as part of my general and specialist psychiatry training. Articles from the BJPsych, in particular editorials and correspondence, featured regularly in didactic presentations and journal clubs, and were a frequent stimulus for discussion and debate. Thus, I admired the journal immensely, but only from afar, as I hadn't published in its pages even though I had co-authored a couple of articles in other journals. Hence, my first meaningful interactions occurred much later and initially comprised mainly letters that commented on the work of others. For me, the most important among these was the letter I wrote critiquing the proposal by Peter Tyrer for a syndromal diagnosis of mixed anxiety and depression that he called ‘cothymia’. My criticism was predictably rebuffed, but the letter remained of significance to me, not because of its content, but because the then editor of the BJPsych, Greg Wilkinson (who died in January 2023), had shown willingness to publish both an intriguing argument based on a novel idea and simultaneously accommodate a robust rebuttal. To me, this meant the journal was genuine about providing a space for ideas and a forum for exercising one's mind. This is one of the reasons why psychiatry is a fertile and exciting field for research.

To ensure advancement, discourse, discussion and debate are essential for our discipline as there is much that is yet to be decided. Since my initial letters to the editor, my engagement with the BJPsych has expanded to that of a reviewer, an author and, in more recent years, I have had the privilege of serving as the Editorials Editor as well as a deputy editor. Now as Editor-in-Chief I aim to develop the journal further – enhancing its real-world impact. In addition, as College Editor for the RCPsych I want to see all the College journals flourish and will be working closely with each of the editors-in-chief to achieve this.

In future editorials I will spell out some of the initiatives through which we intend to realise these ambitions. In the interim, if you are interested in being more actively involved in any capacity and indeed with any of the College journals, I extend to you an open invitation.