Welcome to "Psychiatry at the Margins"

Hello!

I am Awais Aftab, an early-career psychiatrist in the US (currently in the Cleveland area in Ohio) and academically affiliated with Case Western Reserve University. I have been interested in various philosophical controversies and scientific debates that surround psychiatry and related disciplines since the early days of my psychiatric training, and over time I have explored these issues from a variety of different perspectives. You can see more details about the work I’ve done on my personal website. For the most part, this engagement has taken the form of academic publications, an interview series “Conversations in Critical Psychiatry” for Psychiatric Times (a book adaptation with new material is forthcoming from Oxford University Press), and active discussions on twitter with other clinicians, researchers, academics/philosophers, and patients/service users. I have learnt a lot in the process and have frequently changed my mind as a result. I have realized that the mainstream discussions in the field as well as in the general public are often conceptually muddled and scientifically impoverished, and there is a need for commentators who can make our best conceptual and scientific understandings of “mental illness” and “psychopathology” — and the controversies and uncertainties that surround these explanations — accessible to a wider audience. That is a role I hope to play using this blog/newsletter.

The Substack format and the way it allows audiences to support independent writers have opened up new possibilities. Scott Alexander and Erik Hoel serve as good examples of what can be accomplished using this platform. My ambitions of what I can achieve here are comparatively modest. I am hoping to use this newsletter to open a space to synthesize my thoughts and cultivate an audience in a manner not currently facilitated by academic journals or platforms such as twitter.

Target audience

Clinicians, researchers, and trainees in psychiatry and psy-sciences as well as educated patients/service users and laypersons who are interested in on-going philosophical and scientific debates in these areas.

What can you expect?

On average, I am hoping to post several times in a month. The length of the posts will vary — some will be brief paragraphs, others will be essay length. Posts will not be published on a fixed schedule. I am anticipating that my use of Substack will involve a certain degree of experimentation that will result in the development of a style that is more specific to this medium.

I am planning to launch a new interview series in 2023 — tentatively titled “Revisionist Psychiatry.” It will likely be similar in format to Conversations in Critical Psychiatry, but will have a less restrictive focus. (I am unsettled on the issue of whether to incorporate podcast interviews in the series or not.)

The vast majority of posts will be free and publicly-available. This is important to me as I want this newsletter to be widely accessible. There will likely be some subscriber-only content, however to be fully transparent, I haven’t figured out quite yet what exclusive posts will look like. They may involve ask-me-anything threads and subscriber-only discussions. Also, only paid subscribers will be able to comment on posts.

Although most posts will be public, if you have a specific interest in these issues and have the means to support this newsletter, I would encourage you to consider becoming a paid subscriber.

My ideological leanings

I am drawn to what can be described as the integrative, pragmatic, and pluralistic traditions in psychiatry. I am wary of tendencies towards (problematic forms of) neurobiological reductionism as well as social constructionism. I intend to highlight problems with mainstream psychiatric discourse but I will also point out the biases and errors that come up in the “critical psychiatry” discourse. I provide an overview of how I approach these issues in the chapter “Psychiatry and the Critical Landscape” in the forthcoming OUP book adaptation of Conversations in Critical Psychiatry, and I will touch on these issues in later blogposts.

I see myself as engaged in a two-fold mission:

i) To promote a philosophically-informed and scientific practice of psychiatry that robustly engages with the metaphysical, relational, and phenomenological dimensions of psychopathology

ii) To contextualize psychiatry within a broader pluralistic domain of mental healthcare and psy-disciplines, taking into account that it is only one disciplinary approach among other approaches/frameworks (psychoanalytic approaches, neurodiversity movement, Hearing Voices, Mad Pride, other scientific approaches in psychology, etc.) that remain essential and can’t necessarily be subsumed under medicine.

My conceptual and scientific worldview when it comes to psychiatry and psy-sciences is shaped by the work of Derek Bolton, Ken Kendler, Peter Zachar, Allen Frances, Nassir Ghaemi, Dan Stein, Paul McHugh, Sanneke de Haan, Kristopher Nielsen, Ahmed Samei Huda, Nev Jones, Lisa Feldman-Barrett, Mark Solms, Robert Chapman, Mohammed Rashed, Randy Nesse, Eiko Fried, Peter Kramer, David Healy, Nancy McWilliams, Scott Alexander, and David Deutsch. If you don’t know who they are, or how these diverse and at times contradictory influences all mix together, don’t worry, you’ll get to hear more it in this newsletter!

Thank you for your readership and support.

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