Open Thread/Past Links/AMA
My gratitude to the 8000+ people across the world who subscribe to this Substack (and an extra thanks to those who support this newsletter with a paid subscription, even though the vast majority of content is accessible to all). Writing this blog has been extremely rewarding for me, and this would not be possible without the interest and engagement of the readers.
This post is an open thread, and all readers are welcome to comment: share feedback, introduce yourselves, point out theoretical or scientific developments that I should be paying attention to, suggest topics for future posts, etc. You are also welcome to ask me any questions.
For new readers, I am sharing 5 posts from the early days of this newsletter that you may not have seen before. (For the full archive, see here)
The Case for Antidepressants in 2022 — The post that basically launched this newsletter; I discuss how I make sense of the controversy around the efficacy of antidepressants in the acute treatment of depression
Do all roads lead to mitochondria? — My critical review of Christopher Palmer’s “Brain Energy” and the thesis that metabolic dysfunction serves as a unifying theory of psychopathology
Asking better questions about involuntary psychiatric care — The debate around involuntary commitment and treatment of individuals with mental illness rages on. Perhaps we need to start asking better questions than the ones we have asked so far?
Adventures in Personalized Psychopharmacology: A Conversation with David Mordecai — David’s story is a great example of how patients can direct their own care in innovative ways that may not only surprise clinicians but that may also lead to better outcomes
On the Ignorance of Psychiatry and the Ignorance of Critics — A review of Owen Whooley’s book On The Heels of Ignorance
I have also assembled all the interviews and Q&As published on this Substack (13 so far) on one page for convenience.
I am grateful to all the guest writers who have published on Psychiatry at the Margins. The Remaking of a Therapist by Stephanie Foster remains one of my favorite guest posts on this newsletter.
I am open to future guest posts but be warned that I am highly selective about what I publish and there is usually a fair bit of editorial input involved. For those interested, I’d love to feature contributions from Africa, Asia, Latin America, Eastern Europe, etc., that improve our understanding of conceptual and scientific debates in the field or highlight new perspectives on experiences of mental illness and mental healthcare. (I am not, however, interested in rehashing familiar tropes of psychiatric critique.)
Thanks again for your continued readership and engagement.
Hi Awais,
It's interesting to see from the comments below that your sub-stack is frequented by clinicians and patients alike. It just occurred to me to share it with some of my patients.
There are few forums - are there any others?- that are heterogenous this way, and where a clinician can "come out" as also a patient.
As a psychiatrist who was also pretty depressed, for whom meds and other treatments caused serious problems I also think, like David M, about whether the cure isn't often worse than the disease, and I also try to think about partnering with patients. I think I've actually argued with AA about the validity of diagnosis! I almost never insist that people take medication.
But I was trained in the medical model. It seems like we drs don't feel we have anything to offer unless we are prescribing. We want to feel needed and in control, having worked so hard and acquired so much "knowledge." It's interesting to think about how to re-educate psychiatrists to work in tandem rather than in a top-down model. It runs contrary to medical training.
I definitely feel that there's a way in which I know more as a patient than as a dr, though.
My experience, like David's. has been that, in general, non-MD therapists are more able to see patients as equals; there is less of a polarized dynamic. Of course, MDs also worry about their licenses, litigation, etc. But a real partnership between patient and dr seems unlikely to end badly, in my view.Thanks, as always, for some good reads!
I love reading your work! A few questions – would love to hear your take, and any recommendations you have for articles/books/podcasts/interviews/films etc. on these subjects that you think might be useful:
1) What do you make of Thomas Szasz’s idea that mental illnesses are not "illnesses/diseases" but issues of insufficient/misaligned incentives? I understand that profound neurological changes take place in addiction, depression, and other conditions, but I find Szasz’s take to be optimistic in that it A) suggests (much like IFS) that you are not ‘broken’ or wrong for enacting a maladaptive coping mechanism – it is a functional response to the horrors of contemporary life, B) charts a potential path out of a cycle of victimization/helplessness in that it meaningfully differentiates between diseases without a cure (cancer) and mental conditions that may respond to therapeutic intervention and C) in so doing emphasizes the human capacity for change.
2) Do you feel like we have arrived at a moment where affective labor has become too medicalized, in the sense that therapeutic relationships are becoming valorized over simply having a robust friend group?
3) Do you feel like, given the a-political nature of therapy, it has the potential to be truly transformative? In other words, to what extent are our "bad feels" the result of internal cognition/ideation and to what extent are they the result of structures of inequity/capital/social life that make people feel bad?