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Awais Aftab

@awaisaftab.bsky.social

4.9k Following8.1k Followers

Psychiatrist with philosophical interests | Conversations in Critical Psychiatry (Oxford University Press, 2024) | Psychiatry at the Margins www.psychiatrymargins.com

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@awaisaftab.bsky.socialOct 3, 2026, 4:17 PM

My new preprint: Psychiatric Overdiagnosis As Diagnostic Stretching In Response To Clinical Need

osf.io/preprints/ps...

@hermionegingold.bsky.socialSep 29, 2026, 3:04 PMReposted by @awaisaftab.bsky.social

Phew! This post hit the nail on the head.

@haydonmp.bsky.socialSep 29, 2026, 2:06 PMReposted by @awaisaftab.bsky.social

Really important and useful article.

@awaisaftab.bsky.socialSep 29, 2026, 2:00 PM

I am doing a series of articles (“Therapeutic Window”) for the Science desk at The New York Times. The first article is about whether ADHD is better understood as a disorder of “attention” or something else:

www.nytimes.com/2026/09/29/s...

@laurarouth.bsky.socialSep 26, 2026, 7:17 PMReposted by @awaisaftab.bsky.social

“The system is organized around scarcity of attention and time. It is relatively easy to ask for and be prescribed medications, but quite difficult to see a physician who actually cares and listens and thoughtfully attends to diagnostic work-up and treatment risks and patient concerns.”

@awaisaftab.bsky.socialSep 26, 2026, 12:53 PM

I Believe in a Radical Abundance of Relational Care

“The more I practice, the more I believe that attention is the rarest and purest form of clinical generosity.”

www.psychiatrymargins.com/p/i-believe-...

@laurarouth.bsky.socialSep 19, 2026, 8:47 PMReposted by @awaisaftab.bsky.social

In supporting a loved one with a mental illness, I’m painfully acquainted with, and appreciate, what @awaisaftab.bsky.social describes regarding the harms and benefits of psychiatric medication, now both a necessity and godsend for my loved one, and us. Do I wish for something better? You bet.

@schizosemia.bsky.socialSep 19, 2026, 5:58 PMReposted by @awaisaftab.bsky.social

“I feel like the psychiatric profession messed up big in the tone it took when it came to public outreach and mental health awareness efforts. We communicated to people that we have stuff figured out, that we know what to do.”

@alejandrahope.bsky.socialSep 19, 2026, 2:46 PMReposted by @awaisaftab.bsky.social

As always, I deeply appreciate Awais's honesty re psychiatric prescribing, and I so wish I experienced more of that honesty from psychiatrists and other clinicians in my own care.

We have highly imperfect tools at our disposal, and more and more we rely on these tools in situations where their use is less-than-necessary. I am focusing mainly on psychiatric medications here, but psychotherapy is no less imperfect and sought after. Neurostimulation, imperfect as well.
Psychedelics, don't even get me started. Anyway, the point is, there is no refuge. Anyone selling you anything better than
'highly imperfect' in the realm of mental healthcare is a fool or a grifter. (And this includes deprescribing and tapering...)
I don't know, man, I feel like the psychiatric profession messed up big in the tone it took when it came to public outreach and mental health awareness efforts. We communicated to people that we have stuff figured out, that we know what to do. Come to us with your problems and we will fix you! Unfortunately, we know jack shit...When we start treating weak norms of consultation as strong norms, when we assign preemptive authority in areas where only contributory authority is justified, when we destroy traditional cultural means of support to shunt people into medical treatment, we erode people's capacity to meet suffering with the resources they already have or could have had outside medicine. When we rely on interventions that are weak or unreliable and at times harmful in situations where their use is optional and based on unrealistic expectations, we set ourselves up for frustrations and complications. There are situations that are high stakes, that require specialized knowledge, where there is a scarcity of viable alternatives outside medicine, and where deference to experts makes sense, but these are (were?) also rather circumscribed and uncommon.
Thanks to public messaging colored by delulu optimism, many people showing up at the clinics have a misplaced confidence in our ability to scientifically characterize their problems or help them in a timely, efficient, low-hassle manner.
The real message to the public should've been something like: we are an immature science; our treatments are imperfect and flawed; they help some people some of the time, and we don't quite know who will benefit or how much; they come with risks, at times serious risks, and no one can know in advance how they'll affect you; when they work, no one can say how your relationship to them will change over time. If the resources of ordinary life, self-help, and support available to you through family and friends have failed you, then these imperfect tools are available for you, but don't expect any miracles. There is so much suffering out there and we are just scratching the surface. If you seek help, you may find a collaborative doctor who is attuned to your concerns and sensitive to iatrogenesis, but don't count on your luck.
@awaisaftab.bsky.socialSep 19, 2026, 1:02 PM

“Psychiatric treatment is often enough a frustrating affair, for the patient, for the clinician, for the caregivers, basically for everyone involved…”

On imperfect tools

www.psychiatrymargins.com/p/maybe-dont...

@awaisaftab.bsky.socialSep 12, 2026, 1:30 PM

The Lawsuit That Came to Symbolize the Fall of Psychoanalytic Psychiatry: Eric Caplan on Osheroff v. Chestnut Lodge

www.psychiatrymargins.com/p/the-lawsui...

@cdelawalla.bsky.socialSep 6, 2026, 10:32 PMReposted by @awaisaftab.bsky.social

Tons of ~discourse~ about AOC taking meetings with voters in the MAHA block.

I’m about to sit down and write all my thoughts down, but in the mean time, I wrote extensively about my experience trying to survive a horrid pregnancy & I get the vulnerability.

www.psychiatrymargins.com/p/i-am-train...

@awaisaftab.bsky.socialSep 6, 2026, 2:17 PM

Depression & anxiety seem common & familiar but few can appreciate the psychopathological depths possible. Once in a while I come across an Omega level neurosis in the clinic, & it is like witnessing something alien & ancient, a horror & dread with the gravity of a neutron star…

@awaisaftab.bsky.socialSep 6, 2026, 1:11 PM

Defending the Mechanistic Plausibility of Protracted and Delayed Antidepressant Withdrawal

Guest post by Daniel Cohrs

www.psychiatrymargins.com/p/defending-...

@awaisaftab.bsky.socialSep 4, 2026, 1:37 PMReposted by @awaisaftab.bsky.social

Postpartum Psychosis and Diagnostic Sclerosis

The DSM needs postpartum psychosis more than postpartum psychosis needs the DSM

www.psychiatrymargins.com/p/postpartum...

@drkwildschut1984.bsky.socialSep 4, 2026, 6:28 PMReposted by @awaisaftab.bsky.social

Postpartum Psychosis is a well known clinical syndrome, yet not firmly categorised as a disease in DSM and perhaps there’s the issue that this trial reveals.
Timely blog here to elaborate on the matter, by @awaisaftab.bsky.social

open.substack.com/pub/awaisaft...

@awaisaftab.bsky.socialSep 4, 2026, 1:37 PM

Postpartum Psychosis and Diagnostic Sclerosis

The DSM needs postpartum psychosis more than postpartum psychosis needs the DSM

www.psychiatrymargins.com/p/postpartum...

@awaisaftab.bsky.socialAug 29, 2026, 12:39 PM

Lindsay Clancy and the Dream of a World Beyond the Insanity Defense

The absurdity of mad versus bad

www.psychiatrymargins.com/p/lindsay-cl...

@awaisaftab.bsky.socialMay 30, 2026, 12:42 PM

The Ground Beneath the Clinic

On the scope of medical authority

www.psychiatrymargins.com/p/the-ground...

psychiatrymargins.comThe Ground Beneath the ClinicOn the scope of medical authority
@awaisaftab.bsky.socialMay 11, 2026, 1:34 PM

When patients ask, “What disorder do I really ‘have’?” the honest answer is usually more interesting and messier than a single diagnostic label. I wrote for the @nytimes.com on what I wish people understood about diagnoses and the nature of mental health problems.

www.nytimes.com/2026/05/11/o...

nytimes.comOpinion | We’re Thinking About Mental Health Diagnoses All Wrong
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