Our inaugural Praxis editorial competition asked trainees, foundation doctors and students to produce a vision of a day in the life of a psychiatrist in 2050, 30 years hence. We were rewarded with a number of enthusiastic and high-quality entries. This type of task invites writers to decide whether they will create a dystopian vision (more clustering?) or imagine a psychiatric utopia (actual funding increases?). However, all of our authors were able to resist such simplistic traps and recognise that the future is likely to be somewhere between brilliant and terrible.

At a neural level the activity of anticipating the future engages the same brain regions as remembering, including the hippocampus,^{Reference Addis and Schacter1} suggesting that in some profound way we can only imagine what we already know. Phenomenological studies have found that future visualised scenes are more detailed the nearer in the future they are.^{Reference D'Argembeau and Van Der Linden2} So asking our entrants to predict life in 2050 was no easy task.

Margaret Atwood, when reflecting on writing The Handmaid's Tale, said she chose to ‘not put any events into the book that had not already happened in what James Joyce called the “nightmare of history”’.^{Reference Atwood3} Her novel, imagining a future in which women's bodies are controlled for reproduction and dissent is brutally silenced, has many parallels in repressive regimes ancient and present. The past does indeed predict the future. Barring perhaps technological and engineering advances, as Shakespeare wrote in Sonnet 59, ‘there be nothing new, but that which is hath been before’.^{Reference Shakespeare4} Indeed, in writing this Shakespeare is paraphrasing Ecclesiastes 1.9 (KJV) ‘no new thing under the sun’. His editors were obviously less stringent with referencing and attribution than we are here at the BJPsych Bulletin.

Each of our entrants did seem to intuit Atwood's advice, drawing on many past and current concerns and recognising that they are training in a discipline fraught with ethical questions. Reassuringly, the central importance of the therapeutic relationship between patient and doctor was a common thread in all the imagined futures.

Surprisingly few of the entries described the effect climate change is certain to have on our practice, reflecting perhaps the difficulty we all have in facing a crisis in which solutions can seem politically distant. Temperatures predicted to far exceed the 1.5 °C warming at which life on earth is relatively liveable^{Reference Watts, Amann, Arnell, Ayeb-Karlsson, Belesova and Boykoff5} can be a painful reality for us to bear.^{Reference Brenner6} From a mental health perspective floods, famines, migration and fires, such as those seen in Australia last year, are already creating immense psychological trauma. Air pollution even at current levels is associated with increased risk of dementia.^{Reference Peters, Ee, Peters, Booth, Mudway and Anstey7}

However, we could usefully imagine a psychiatry in 2050 practised in a world in which fossil fuels have been rapidly removed, and following scientific advice, governments have responded appropriately to the scale of the crisis. An important step forward for psychiatrists in this regard was the decision by the RCPsych to divest from fossil fuels.⁸ Perhaps air pollution could be minimal and beneficial plant-based diets standard,^{Reference Kim, Caulfield, Garcia-Larsen, Steffen, Coresh and Rebholz9} and all academic professionals could employ available technology to interact across continents rather than flying to conferences.^{Reference Green10}

Reading the excellent submissions, I began to dream of my own 2050 vision. I pictured a psychiatry where people with lived experience are co-producing all health services and research, working as genuine partners in positions as ‘patient-leaders’ as described by David Gilbert.^{Reference Gilbert11} By 2050, there has been a steady erosion of paternalism and patients are involved in decision-making in all aspects of their care. The ICD-20 has been co-written by people with lived experience, and perhaps the construct of personality disorders has been replaced by a nuanced understanding of the effects of developmental trauma. MDMA-assisted psychotherapy has made recovery accessible and achievable for many survivors of trauma.^{Reference Mithoefer, Feduccia, Jerome, Mithoefer, Wagner and Walsh12} Advances in neuroscience, following the trend of growing understanding of functional neurological disorders,^{Reference Edwards, Adams, Brown, Pareés and Friston13} mean that ‘medically unexplained symptoms’ are now fully explained.

By 2050, education and training are co-created, from curricula development to examinations,¹⁴ and the value of lived experience is appropriately remunerated.^{Reference Soklaridis, de Bie, Cooper, McCullough, McGovern and Beder15} Although no longer completed on paper since the banning of printers in the 2030s, ‘Paper’ A will include a module on historical use of language. Trainees are shocked at how freely expressions like ‘treatment resistant’ and ‘manipulative’ were used in the past in relation to people seeking help, for whom some of our treatments had failed. Following medical students’ early exposure to special study modules, including those on film, literature and mental health, longitudinal placements and student psychotherapy schemes,¹⁶ core psychiatry training is consistently oversubscribed. The number of specialist registrars approaching completion of training is just enough to meet demand for the thousands of new posts as funding for mental health finally reaches parity. A flexible, 4-day working week¹⁷ is now the norm, with benefits for the well-being of psychiatrists and patient outcomes. Retirement age has been deferred to 75, but all pension issues of the 2020s^{Reference Trueland18} have been resolved.

Most of the entrants were more realistic in their visions than I. Indeed, many described technology or advances which are close to or already being used, such as voice recognition software, video consultations, monitoring apps, podcasts, or screening for autoimmune antibodies.

Excellent shortlisted entries included those from Rebecca Akroyd, Shevonne Matheiken and Sarah Orr. Rebecca Akroyd explored wearable technology for identifying relapse, as well as the use of capillary nail bed measurements to check full blood counts for patients taking clozapine, in what the judges described as an ‘original’ and ‘well-researched’ piece.

Shevonne Matheiken's perspective of a medical student on placement reassured judges that technology was a support and not a dominating feature in ‘providing holistic, patient-focused care’. I also particularly enjoyed the reference to ‘bot-inclusivity mandatory training’.

Sarah Orr ‘articulated a hope that the future will see greater links between health and social care’. Her entry wryly cautioned against ‘automatic referrals from electronic therapists’ where a patient protests ‘I said I was going to the SEA-side but the computer just doesn't understand the Scots accent’.

George Gillet's ‘A day in the life of a psychiatrist in 2050: where will the algorithm take us?’^{Reference Gillet19} was a standout overall winner. His piece utilised the dual perspectives of a patient and psychiatrist as they navigate a world of digital phenotyping, questioning whether technology can predict or alter suicidal thinking. Resonating clearly from Gillet's editorial is the fundamental importance of a human connection in therapeutic relationships. The judges described it as a ‘very engaging’, ‘well-crafted’, ‘wonderful, moving piece which melds future psychiatry with patient-centred care’. You will find George's winning entry in this issue of the BJPsych Bulletin, and he will receive his award at a ceremony to be held during the RCPsych International Congress 2020.

We are grateful to our esteemed and generous judges, Simon Rose and Drs Ross Runciman, Kate Lovett and Ian Hall, who read and commented on the shortlist. BJPsych Bulletin editor Dr Norman Poole also deserves special mention for reading all the entries over Christmas and for managing to agree a shortlist with me.

Returning to the nearer future, the theme and judges for the 2021 Praxis Editorial Competition will be announced at the 2020 RCPsych International Congress. Keep an eye on the BJPsych Bulletin website and Twitter (#BJPBulletin) for further details. Thank you to all those who invested time in sending us entries this year, and for your thoughtful, hopeful, sometimes revelatory and occasionally terrifying forecasts. Margaret Atwood says the literature of witness, of documentation, is ‘an act of hope’.^{Reference Atwood3} ‘Every recorded story implies a future reader’,^{Reference Atwood3} so keep writing.