The Journal of the American Academy of Psychiatry and the Law is published four times a year. But it is created every day in a series of countless individual and often unremarkable steps. A network of authors, reviewers, editorial board members, office staff, publishing staff, and senior editors continually interacts in a complex metabolic chain. The Journal's web of life pulses on, day by day. And its being is self-aware; we (the editorial staff) are mindful of our actions, our decisions, our choices. That is a sufficient level of consciousness to enable a significantly productive and accomplished enterprise. And further evolution is possible.
After 10 years of my immersion in this dynamic process and more than 40 issues worth of editing experience, it occurred to me that it was time for a journalistic retreat—a period of deliberate self-examination and discovery. The way forward would be served well by taking stock of our present status and identity, challenges, opportunities, questions, and unresolved concerns. Toward this end, I began to assemble an outline of achievable inquiries about forensic publishing in general and The Journal in particular. The content of the list that developed was not drawn from any particular structure or methodology, in part because I could not find one. I have attempted multiple keyword searches of the medical literature to find examples of journals that have engaged in such a process, with no real success. That does not mean, of course, that such endeavors have not been made, but I am unable by this approach to find any publication of the results of such systematic efforts. This special section represents the product of such an undertaking, perhaps the first of its kind.
The lines of inquiry for the self-examination are the product of perceptions drawn from diverse editorial encounters that have impressed me in some memorable or significant way. I do not assert that these particular inquiries are exhaustive or privileged. I do think that they represent a sensible enough beginning to the task of self-examination for The Journal. I hope that they will capture the attention of American Academy of Psychiatry and the Law (AAPL) members and other readers in ways that will promote a sustained and vital attitude of self-examination in our publication activities. The paths to enlightenment can be as numerous as those who seek it.
The Selected Inquiries
Mission/Vision
When the child in the backseat pipes up and asks, “Are we there yet?”, it is easy enough to dismiss the interrogation as a cranky complaint. But to consider the question seriously, one has first to know where one is going and where one is now. Such is the heart of an organization's vision and mission, which is a very good place to begin the examination.
Most journals have some sort of statement of mission. The New England Journal of Medicine refers to its “Mission Statement.” The American Journal of Psychiatry and Psychiatric Services use the term “Mission and Editorial Policy.” The American Journal of Forensic Psychology describes its “Scope.” JAMA takes a somewhat different approach, identifying its “Key and Critical Objectives.” Journals such as Law and Human Behavior, The International Journal of Law and Psychiatry, The Journal of Forensic Psychiatry and Psychology and our own Journal do not label their mission statements as such, although they clearly identify their purpose, identity, and goals.
The Journal has made significant amendments to its front pages of author instructions since 2011, to clarify structural and technical details, but more important, to clarify the elements of our purpose, methods, and goals. In the article in this section by the Editors, the details of that evolution are discussed and expanded on in a broader review of several dimensions of the attempts to pursue the mission and realize the vision of The Journal.1
Achieving the Educational Mission
AAPL is “dedicated to excellence in practice, teaching, and research in forensic psychiatry” and has as its overarching goal the promotion of “scientific and educational activities in forensic psychiatry.”2 It strives to fulfill this goal, in part, through publications such as The Journal. The educational objectives in forensic psychiatry encompass a broad and deep terrain. It is one thing to publish individual articles of high quality and relevance to the field; it is another to disseminate a body of work over time that adequately addresses the wide range of topics inherent to the educational mission of the parent organization. There is thus good reason to ask how well The Journal has been fulfilling this assignment.
In a recent content analysis searching for the appearance in various forensic journals of 16 key terms in forensic psychology, Piotrowski3 reported that The Journal performed very well in comparison to other journals. For this special section, Pinals and Frierson4 were asked to explore, via a different methodology, how well The Journal is contributing to the educational mission of AAPL. They examined the subjects of Journal articles over a five-year period in comparison to topic areas of standardized educational indices for forensic psychiatrists—the first known attempt of its kind. They review the strengths and some weaknesses of The Journal in covering topics important to the education of forensic psychiatrists, within a broader discussion of life-long learning.
The Use of Case Reports
The management of case reports has been the subject of considerable efforts in revising Journal policies and Instructions for Authors. Stories of real people are often captivating; they enliven medical writing and illustrate principles in memorable ways, thus enhancing teaching objectives. Case reports are of particular interest to mental health professionals because of our attention to narrative methods of practice and teaching.
But there is a tension between the author's and reader's interests on one side and those of the subjects of the reports on the other. Respect for persons requires a serious attempt to balance those interests and sometimes to preempt the interests of authors, despite their best efforts to respect the subjects of their writing. The discussions with authors can be complicated and protracted, and the final decisions can rest on judgments rather than the obvious application of a clear rule.
In their analysis of this topic, Hanson, Martinez, and Candilis5 review the history of case reports in medical literature and the development of various guidelines on the practice. They perform an examination of the standards employed by leading journals and offer an analysis of the ethics of using case reports, as well as recommendations for publishing practice, including changes to Journal policy.
Peer Review
Peer review is one of the most basic components of medical journal editing, but it can also be one of the most perplexing. One of the intriguing lessons of my editing experience is that the merits of peer review are more obvious from a distance than they sometimes are up close and personal. One review for a manuscript will recommend immediate acceptance and rank it at the top of the scale. Another review on the same manuscript will recommend immediate rejection, suggesting that the work is irredeemable and its publication unimaginable. (When I read legal decisions touting Daubert's6 peer review factor for the admission of expert testimony, I have to smile—just a little.)
It is not at all easy for an editor to convey to an author that a manuscript is both superb and fatally flawed, according to blind reviewers involved in a process designed to be objective and fair. How does one understand the dreaded 2-9 split except by acknowledging the inherent subjectivities and esthetics of the process? I appreciate the ameliorative potential of the recent advice to reviewers from neurologist Clifford Saper, which appeared under the subheading “Sweetness and Light”: “Once you write a review, try to reread it from the point of view of the author. … Try to keep in mind how vulnerable you feel when you are reading a review of your own work. Be kind to the author, even if your final recommendation is not to publish the work” (Ref. 7, p 177). These thoughts are in line with the approach I have taken to conveying disparate reviews to an author in a way that attempts to make some coherent sense of the divergent opinions and offers a potential direction for revision or other future action.
Fortunately, this scenario does not occur commonly, but when it does, it raises for me serious and nagging questions about how well we have conceptualized and equipped the methodology and mechanisms of peer review. Thus, I was keenly interested in including the subject of peer review as part of this first examination of forensic publishing.
In this section, Felthous and Wettstein8 offer a far-reaching and erudite analysis of the value, limitations, and critiques of peer review. Their scholarly review of the literature on the subject and the recommendations they suggest for improving the process will stimulate useful thought and serious discussion in future Editorial Board meetings.
Open-Access Publishing
Every week I receive one or more (insincerely) personal e-mail offers to submit my work to a new open-access publication promising vibrancy, immediacy, and scholarly recognition. The e-mail usually also invites me to understand and appreciate the value of my paying to have my work published so that it may be enjoyed freely by the widest audience. While I am not personally tempted to engage in this new and largely untested domain, there is merit to the idea of free open access to all readers.
The Journal is in a fortunate position, through the financial and educational contributions of AAPL members, to be able to provide such access while maintaining all the quality control procedures—and costs—of traditional publishing. This situation will not necessarily be true for other organizations or further into the future, especially as the costs of print media continue to rise and the economics of electronic-only publishing become more attractive. Every year, there is a discussion in the AAPL Council about the cost to the organization of The Journal's current open access online availability. It is possible that the balance may tip at some point and a different decision will be necessary.
When Newsweek went out of print, I stopped reading it. It had some value to me as a tangible object in my hand. I have never once been drawn to the online version. Of course, this is a matter of personal preferences and, admittedly, age. But these considerations are also applicable to all print journalism and will be relevant to future discussions about The Journal.
For AAPL membership and The Journal leadership to have informed discussions requires that we begin to understand more about electronic-only and open-access publishing, and the ways in which these modalities may be pertinent to forensic publishing. Knoll9 provides a primer on these topics in this special section, one that I hope will permit more of us to engage knowingly and intelligently in the discussions to come in the years ahead.
Conclusion
The emergence of electronic and open-access journals is the latest wave of expansion in the volume and complexity of medical publishing. An editorial recently published in JAMA decried the “excessive zeal in publication” and the “tremendous multiplication of published … contributions and reviews in the field of medicine.” That editorial was first published more than 100 years ago.10 The early 20th century JAMA editors asserted that, “Sooner or later a policy of frank, unrelenting editorial scrutiny must be adopted on a broad scale in medical journalism and scientific publications in general.”10
While The Journal does not face the same “flood of papers” problem that aroused the JAMA editors, the same interest in quality and effective communication of medical literature motivates the efforts of this special section. Each of these articles contributes rich material for enduring development of The Journal. I hope that our readers will find value in these explorations and will be encouraged to participate in a new round of ongoing conversations about forensic publishing and especially about The Journal in its present form and possible future iterations.
Footnotes
Disclosures of financial or other potential conflicts of interest: None.
- © 2014 American Academy of Psychiatry and the Law