Excellent work with an all-star team, Awais--kudos and congratulations!

Yes, eliminate "essentialism" and promote pluralism on many levels. That, I think, is the "take home" lesson for psychiatry and philosophy.

Re: Dr. Denys' comment:

"All psychiatric symptoms are ultimately defined on the background of what is commonly agreed upon as normality. Normality is established not by science but by society. Normal is individual behavior that conforms to the most common behavior."

I think much more can and should be said about this claim. The issue, I think, is not how "symptoms" are defined in psychiatry, but how disease entities or disorders are defined--and that means invoking distress and impairment (or, as I would put it, "suffering and incapacity"). [1] The matter is not settled on the basis of what is "most common" or least common. An IQ of 180 is extremely uncommon, but it would not--all other things being equal-- be grounds for identifying a disorder or disease.

Of course, these terms--distress, impairment, incapacity, etc.--are themselves societally defined. But this is true throughout all of clinical medicine. Thus, the claim that psychiatry is driven by "societal" factors (rather than by "science", however we define that) really tells us very little about psychiatry per se.

As the saying attributed to Hippocrates puts it, "If sick men fared just as well eating and drinking and living exactly as healthy men do . . . there would be little need for the science [of medicine]."

Again, Awais, congratulations on this important contribution!

Best regards,


Ronald W. Pies, MD

1. https://www.psychiatrictimes.com/view/what-should-count-mental-disorder-dsm-v

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May 21Liked by Awais Aftab

Dr. Manfred Spitzer and his friend, Dr. Michael Schwartz who formerly lived and practiced in Austin, spoke at the university where I was employed for more than 30 years. Afterwards, my wife and I were invited to dine at Dr. Schwartz's home where we also sang and enjoyed stimulating conversations. Interestingly, Dr. Spitzer resided in a German home that was once occupied by Dr. Albert Einstein.

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Tremendous news, many congrats Awais!

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