This month’s (August’s) edition of the British Journal of Psychiatry features an editorial entitled, “Antipsychotics: is it time to introduce patient choice?”. The authors (Anthony P Morrison, Paul Hutton, David Shiers and Douglas Turkington) make an important and provocative argument (given the journal in which their editorial appears – which is not best known for heterodoxy within psychiatry), which is grounded upon an interrogation of “whether everyone who meets the criteria for a schizophrenia spectrum diagnosis requires antipsychotics in order to recover.”
There have, to date, been nine letters published by the BJP responding to this article. One of them is mine (“Long-standing arguments from the service user movement reprised in the BJPsych”). Notably, none is by a self-identified psychiatrist – a fact certainly worthy of reflection.
What narrative options are afforded to letter writers to scientific/medical journals? “N”, the author of the blog Ruminations on Madness, is the author of a letter responding to the editorial that the BJP has, to date, not published. N has posted that unpublished letter online – thereby entering it into what I fantasize can become part of a dispersed and virtual archive of ‘not-published-letters’ that future historians of psychiatry will be able to use as a rich source. N has also written a fascinating analysis of the 9 letters that have to date been published, arguing that:
there are two, fairly clear categories: letters from established academics (none of whom, whether they are or aren’t, explicitly describe themselves as user/survivors) and … two accounts from “unambiguous” service users. The former are predictably ‘academic”—i.e. any obvious (non-empirically grounded) descriptions of experience and sociopolitics inevitably involve others, not the letter writer—whereas the latter revolve around (and to a large extent rhetorically depend on) rich personal self-description.
N concludes by arguing that the editorial decisions by the BJP on this occasion contributes to the “relentless fortification and re-fortification of the ‘first person account’ and/vs the properly academic commentary”.
N’s post made me think in much greater detail about how I imagined my own narrative options as a letter writer. My letter would belong to the group that N categorises as “letters from established academics (none of whom, whether they are or aren’t, explicitly describe themselves as user/survivors).” I know that I redrafted my letter a number of times prior to submitting it. In the process, I shifted its register, the implied reader, and, not least, the narrative voice. In its earlier iterations, the letter was grounded within – and took as its well-spring – the service user movement (to use a complex abstraction, if ever there were one). For a number of complex reasons, I positioned myself in later iterations of the letter (including in the version that was published) as in some ways to one side of the service user movement. While one of my (honorary) affiliations is listed as the Service User Research Enterprise, a unit in which the vast majority of staff use, or have used, mental health services, the published letter’s narrative voice appears to usher – I think – more obviously from the medical humanities, as well as from human rights advocacy. (I list, alongside my position in Durham’s Centre for Medical Humanities, another affiliation – the international human rights organization, the Mental Disability Advocacy Center.) The letter thereby comes to ‘represent’ the arguments of the service user movement without necessarily being part of it. Thus the published letter sits much more obviously on the ‘academic’ side of N’s divide between the ‘academic’ and the ‘personal’, whereas it had, in its origins, perhaps tried to scuff the dividing line.
My exchanges with N on such matters have also made me see anew the challenges I face as a historian of psychiatry who reads letters in psychiatry (and related) journals from the twentieth century. How, in short, do I read, and interpret, and frame, those letters – and those letter writers? How ought I try to think through the generic constraints, as well as the range of possible narrative voices, that shaped (in not entirely conscious ways) the letters of those who wrote, for example, to the editors of US psychiatric journals in the 1960s? How do I try to understand what drove some (male) doctors in the fin-de-siècle to write letters to journals such as the British Medical Journal or the Lancet, in which they publicly claimed for themselves the new nosological category of agoraphobia? How do I attempt to infer the kinds of editorial decisions that determined, at different moments, which letters were published or not? I know of a few examples of famous/notorious cases within psychiatry of letters being ‘sat on’ by editors (because of the controversies surrounding the research to which the letters were responding), or of the full list of letter authors transmogrifying upon publication into a lonely sole author. But a fuller history of the “letter to the editor” remains – at least to me – obscure.
Is there a body of work out there by medical humanities scholars and historians of medicine/science that carefully analyses the generic constraints of “letters to the editor” of medical and scientific journals? Are there case studies that explore particular historical moments at which that genre was cemented or transformed? And are there – and this is perhaps what I am most gripped by – analyses that have pieced together fugitive archives of that lonely artifact, the unpublished letter to the editor?