Notable Links & Miscellanea - March 15, 2025
#1. Congratulations to Stephanie Foster on receiving honorable mention in the Excellence in Journalism award by the American Psychoanalytic Association (APsA) for her article “The Remaking of a Therapist,” which I’m proud to say was published as a guest essay on Psychiatry at the Margins on September 3, 2023.
#2. In an article “A Proposal for the (Re-)introduction of Amdisen Standardized Lithium Levels” (2025) for Bipolar Disorders,
has proposed a new notation for reporting serum lithium levels that focuses on time post-dose and dosing regimen. and I are co-authors on the paper. In a 1977 paper, Amdi Amdisen introduced standardized conditions to take lithium serum samples: a lithium serum concentration drawn in the morning, 12 h (± 30 min) post-dose for a patient on a multiple daily dose regimen at steady state. The practice was adopted by the psychiatric community, but the notation “12 h—standardized serum lithium” was not, and additionally, many patients are now on once-daily regimens. We propose three lithium levels named after Amdi Amdisen to replace the 12 h-stSLi notation. These are the “Amdisen level,” “Modified Amdisen level,” and the “Non-Amdisen level.”
It’s worth mentioning here that Alex Mendelsohn is not a psychiatric clinician, but a physicist based in the UK! He has personal experience of using lithium for a mood disorder. In 2023, he wrote “Lithium story: eight guidelines, eight recommendations” for Lancet Psychiatry, in which he told the story of how he navigated the confusing and contradictory literature on lithium serum concentrations to figure out a dosing schedule that worked best for him and to persuade his psychiatrist. He also wrote a guest post for Psychiatry at the Margins in July 2023, “Psychiatry needs more simulations: the case of serum lithium concentrations,” and he now has a substack of his own, The Psychiatric Multiverse. Alex wonderfully exemplifies how psychiatrists can benefit from more scientific collaborations with patients. [Owen Muir also covered the paper in his substack post, More Patients As Science Authors, Please.]
#3. Speaking of new Substacks…
Robert Chapman (
) is now on Substack as well: Neurodiversity and Capitalism. Check out their posts “Quitting Work and Depression” and “Neurodiversity and the Myth of Moral Decline.” Robert is a philosopher and social theorist, and identifies as being autistic. I have had great admiration for their philosophical work and have learned a great deal from engaging with it. I initially interviewed them as part of my Conversations in Critical Psychiatry series and subsequently for this substack as well when their book “Empire of Normality” was published.
Fellow psychiatrist
has started a substack blog, and his first post is: “The Best Evidence for Antidepressants Has Never Been Published...and Never Will Be”- is a mathematician and author of Mathematica (2024). I was delighted to discover his reflections on this platform on the nature of mathematics. See his posts “We've been wrong about math for 2300 years: A radical conceptualist take on the foundations of mathematics” and “Beyond nature and nurture: How mathematics changed my view on talent.”
#4. Grace Lindsay in the Transmitter — Claims of necessity and sufficiency are not well suited for the study of complex systems
“As the comparison to the philosophical definition makes clear, however, claims of necessity and sufficiency are not actually well suited for the study of complex systems. In part, this is because these terms enforce a “thing” rather than “process” approach. By treating behaviors as nouns that can be defined by necessary and sufficient conditions, this approach downplays the fact that behavior is the emergent result of complex interactions between many neural components. Under a “thing” approach, it makes sense to try to attach necessary and sufficient claims to behaviors. But under a “process” approach, the focus would shift to building a model that recapitulates the dynamical neural system that gives rise to a behavior, along with all the ways it can be altered.”
Readers may recall that the sufficiency criterion has been the focus of debate in recent philosophical literature on the ‘Are mental disorders brain disorders?’ question, driven by Anneli Jefferson’s work.
See my paper ‘Mental disorders in entangled brains’ in Philosophical Psychology and Jefferson’s response to mine and other commentaries.
#5. Adrian Kind reviewed my book “Conversations in Critical Psychiatry” (OUP, 2024) for the journal Philosophical Psychology. He is very considerate and thoughtful, and I’m grateful to him for his discussion.
“All in all, “Conversations in Critical Psychiatry” is a very welcome and timely publication that allows the reader to quickly get a top-level overview of topics that are currently of high interest within critical psychiatry, through the lucid medium of interview conversations supplemented by a good guide on how to follow up on topics that came up in the presented conversations with more academic rigor. Whether one just have a few minutes to read one of the interviews during a break at work or on the bus, or if one is willing to commit to going systematically through the book, there is much to gain for the reader. It is a book for philosophers, scientists, and clinicians, a book for anyone who, in one way or another, cares about psychiatry and where it is heading at the moment.”
#6. Readers of Psychiatry at the Margins will remember my post “Borderline Personality and Self-Understanding of Psychopathology,” which was written in response to an article by Jay Watts on the epistemic injustice of borderline personality disorder.
Orestis Zavlis has recently responded to Watts in a preprint in which he argues that what matters most isn’t the diagnostic label but rather what the label represents. He makes the case that the solution to epistemic injustice associated with borderline personality is not to abandon or deny the concept, but to understand it appropriately as a relational disorder. (See also: Either all psychopathology is personality psychopathology or there is no such thing.)
Zavlis (with Fonagy, and Luyten as co-authors) has also published a stimulating correspondence in Lancet Psychiatry, titled “The most important aims of psychotherapy: to love, to work, and to find meaning,” in response to qualitative meta-analysis of client-identified outcomes of psychotherapy. They used a natural language processing method to reveal semantic similarities among nine outcome clusters to show that they fall into three sentiments of love (relational functioning), work (capacity to cope in adaptive ways), and meaning (emotional stability and meaning in life).
#7. I am happy to share that last month’s touching and profound guest essay by Susan Mahler, “Confessions of an Ambivalent Psychiatrist,” has become the most liked post on Psychiatry at the Margins.
#8. A wise new paper by Dan J. Stein and Randolph Nesse offers a useful corrective to tendencies towards “tacit creationism” in neuroscience — “Tacit Creationism Encourages Oversimplified Views of Functions and Dysfunctions”
“Notions of function and dysfunction are fundamental for neuroscience, psychology and psychiatry but remain contentious. We propose that some of these controversies arise from ‘tacit creationism’, which disavows a designer but nonetheless views bodies and brain-minds as if they are products of conscious planning with discrete parts that serve specific functions. Many philosophers agree that ‘failure to perform a normal function’ is fundamental to the concepts of physical disease and mental disorder. However, unlike machines and computers, no blueprint defines a single normal phenotype for bodies and brain-minds. Instead, varying genes interact with one another and environments to create individuals who vary in ways that give advantages and disadvantages that depend on the environment. Many clinically relevant variations influence the gain in control systems for adaptive responses such as anxiety and low mood, making it difficult to draw a bright line between normal and excessive activation of distressing emotions in a particular context. Literal interpretations of the metaphor of body as machine or brain-mind as computer encourage essentializing normality and pathology—expecting functions to be as specific as those for parts of machine and dysfunctions to involve discrete anatomo-physiological or molecular defects corresponding to broken parts. Rejecting tacit creationism, and accepting the messy reality of organic complexity, the fuzzy boundaries of disorders and the multiple difference-makers that contribute to pathogenesis offers a better way forward for neuroscience, psychology and psychiatry.”
#9. My appearances on podcasts and interviews:
David Puder’s top-rated podcast Psychiatry & Psychotherapy — Episode 235: The Serotonin Hypothesis: Controversies and Nuance with Awais Aftab, MD
- ’s Depth Work — Rethinking Assumptions Within Psychiatry & Developing Conceptual Competence
Deprescribe with
— The Intersection of Psychiatry and Philosophy, Conceptual Competence, Reviewing SSRIs and New Mechanisms of Action, The Challenges of Deprescribing in Psychiatry, and More- ’s Digital Gnosis — Mind & Medicine w/ Dr. Awais Aftab
#10. Wonderful video discussion by
— wtf is critical adhd studies?