Profiled in Lancet Psychiatry

The Lancet Psychiatry, a leading international psychiatry journal, has published a profile on me in their latest issue, in which I am described as “one of the discipline’s foremost public intellectuals.” The profile mentions this Substack, Psychiatry at the Margins, as well as my Psychiatric Times series “Conversations in Critical Psychiatry” and the Oxford University Press book adaptation.

Lancet Psychiatry profile, written by Talha Burki

This is also a good opportunity to mention that I’ve been awarded the 2025 Bicentennial Lectureship Award by the Institute of Living, a prestigious psychiatric institute with a long history, “awarded to an outstanding individual in the early stages of their professional journey… who [has] demonstrated an impact through their work in innovation, advocacy, and patient-centered care.”

These are no doubt tremendous honors for me. A part of me is still surprised that this is how things have turned out in my life.

I’m not quite sure why, but among the various career accomplishments I’ve had, the Lancet Psychiatry profile holds some sentimental value. A recognition, perhaps, that I have not been speaking into the void. A reassurance that, despite what doubts my inner critic may water, I am not an imposter. I have no illusions of grandeur. I am fortunate to have worked with and to have been acquainted with brilliant clinicians, researchers, academics, authors, people likely a full standard deviation above me in terms of intellect, and thanks to that, I am well aware of my own limitations and fallibility.

The public-facing role that I have stumbled upon, I see it as one of continuous learning and discovery. It demands a great deal of epistemic humility. What I fear is intellectual stagnation and ideological capture. I hope that will not be my fate, and I rely on you all to keep me honest. Thank you for accompanying me.

Some excerpts from the profile:

“Awais Aftab's first love was philosophy, but career options for professional philosophers in Pakistan are limited. Besides, asking searching questions about God and faith is a risky business in a country with blasphemy laws. “I felt like a heretic as I came of age. I could not bring myself to accept the dogmatic manner in which many practised religion in Pakistan. There was a lot of friction between me and the society around me”, recalled Aftab, Clinical Assistant Professor of Psychiatry at Case Western University (Cleveland, OH, USA) and one of the discipline's foremost public intellectuals…

Aftab's efforts are located at the intersection between philosophy and psychiatry and are underpinned by his dissatisfaction with what he describes as psychiatry's lack of “conceptual clarity”. He argues that clinical and research programmes are driven by a welter of implicit assumptions that continue to distort practice, and addressing this requires foregrounding conceptual competence in psychiatric training.

Aftab pointed out that the past 20 years or so have seen the collapse of the neo-Kraepelinian idea that, within the realm of psychopathology, there are discrete diseases that can be readily identified. Researchers attempting to understand conditions such as depression and schizophrenia are discovering a jumble of dimensions and mechanisms that do not converge on anything straightforward. “We are in the middle of trying to figure out how personality characteristics, genetic vulnerabilities, childhood development, adversity and life stressors, brain circuitry and neuroplasticity, and sociocultural factors all interact to generate disordered states”, noted Aftab. He is wary of one-dimensional answers and is drawn instead towards pluralism and integration. He is provocative in a manner that appeals to the philosophically minded, for example, describing psychopathology as “a social construction that is nonetheless grounded in biology and behaviour”.¹

The hidden assumptions that Aftab seeks to illuminate can have a profound effect on how patients understand themselves. He cites evidence that suggests that reducing biopsychosocial problems to brain malfunctions that are empty of psychological meaning promotes stigma and pessimism about recovery, and adversely affects interpersonal relationships. “We have spoken about mental illness in a certain kind of way for the last three decades and it turns out that that way of speaking has a lot of negative downstream consequences”, said Aftab.

Reading Aftab's blog posts, one can often discern his discontent, especially when it comes to topics which have a direct impact on patients. “I think most practitioners operate on a day-to-day basis, in their work, as well as in their engagement with the public, while being conceptually muddled”, he told The Lancet Psychiatry.”

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In addition to any personal virtues I may possess, there is certainly a lot of luck involved — right place, right time — and there is also a whole community of folks who have made this possible. A fraternity of teachers, mentors, friends, readers, who went out of their way to guide me and support me. I don’t want to turn this post into a long list of names, but I feel compelled to express gratitude to several people.

A particular thanks to my collaborator and friend, Dan Stein; I appreciate you. Scott Waterman, Peter Zachar, John Sadler, and other friends from the Association for the Advancement of Philosophy and Psychiatry (AAPP), my heartfelt gratitude for providing me with an intellectual home. Allen Frances, for his generous encouragement over the years. Nev Jones, an exemplar of intellectual and moral courage. Richard Gipps, the wisest clinician-philosopher I know. Dost Ongur, a role model of scientific integrity and sagacity. Ronald Pies, a fellow traveler and well-wisher. Two people without whom the trajectory of my career would’ve looked very different: Ali Madeeh Hashmi and Asim Shah, who took me under their wings at a vital and vulnerable time of my life. My residency directors and mentors, Susan Stagno, Katie Cerny, and Jeanne Lackamp, who created the conditions for me to flourish in training. And someone with whom I’ve had limited interaction but who is an intellectual hero of mine, Kenneth Kendler. All the readers and subscribers of this newsletter!²

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If you are a relatively new reader to Psychiatry at the Margins, start with the following posts

• People Are Stumbling From One Misguided Narrative About the Medical Model to Another

• Psychopathology, Exhaustion, and Identity

• Gender Identity, Biological Sex, and Psychopathology: Back to Basics

• Mental Disorders Both Are and Are Not Brain Diseases

For a starter pack of academic writing:

• Psychiatry and the Critical Landscape

• Philosophy of Psychiatry: Theoretical Advances and Clinical Implications

• Psychiatric Diagnosis: A Clinical Guide to Navigating Diagnostic Pluralism

• Psychopharmacology and Explanatory Pluralism

• Conceptual Competence in Psychiatry: Recommendations for Education and Training.

And some articles for general readers:

• A Psychopharmacology Fit for Mad Liberation? (Asylum magazine)

• What a psychiatric diagnosis means – and what it doesn’t mean (Psyche)

• Prozac Is Nearly 40 Years Old. Why Are There Still Unanswered Questions? (New York Times)

Comments are open.

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Meditations on Success and Flourishing

Reflections on “Psychiatry at the Margins”

1. I was referencing Shane Glackin when I said that.

2. There are so many others; apologies to everyone not mentioned here. There is a longer list of acknowledgements in the preface of Conversations in Critical Psychiatry as well.