Awais Aftab
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awaisaftab.bsky.social
Awais Aftab
@awaisaftab.bsky.social
7.8K followers 5K following 1.2K posts

Psychiatrist with philosophical interests | Conversations in Critical Psychiatry (Oxford University Press, 2024) | Psychiatry at the Margins www.psychiatrymargins.com

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Psychology 39%
Philosophy 32%
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Reposted by Awais Aftab

devezer.bsky.social
Berna Devezer @devezer.bsky.social · 2d
circling p-values right below .05 to infer something about the invalidity of inferences (or even research misconduct) is conceptually no different from calling p-values right above the threshold marginally significant. makes no sense to deride one of these practices while upholding the other.

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 3d
The Clinical Craft of Psychiatric Medication Tapering: Q&A with Anders Sørensen

“Withdrawal teaches you, as the clinician, that you don’t control the process. Successful tapering is inherently patient-led, and there’s a kind of humility in accepting that.”

www.psychiatrymargins.com/p/the-clinic...
The Clinical Craft of Psychiatric Medication Tapering: Q&A with Anders Sørensen
“Withdrawal teaches you, as the clinician, that you don’t control the process. Successful tapering is inherently patient-led, and there’s a kind of humility in accepting that.”
www.psychiatrymargins.com

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 3d
“RCTs or STFU” is its own form of fundamentalist dogma in medicine that is ultimately incoherent and self-serving.

Reposted by Awais Aftab

profpash.bsky.social
Travis Pashak @profpash.bsky.social · 4d
@awaisaftab.bsky.social is amazing, as usual. Loving this post.

Regarding DSM diagnostic criteria: "A best guess is fine as a starting point, but it cannot be treated as something special or sacred..." as it is basically a "pulled-out-of-the-ass threshold"

www.psychiatrymargins.com/p/6-suggesti...
6 Suggestions for DSM-6
Making the next DSM look less like a house of mirrors
www.psychiatrymargins.com

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 5d
6 Suggestions for DSM-6

Making the next DSM look less like a house of mirrors

www.psychiatrymargins.com/p/6-suggesti...
6 Suggestions for DSM-6
Making the next DSM look less like a house of mirrors
www.psychiatrymargins.com

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 7d
I am truly honored by the piece Daniel Oppenheimer (a wonderful writer & podcaster) wrote about me for Psychotherapy Networker, a generous profile (with kind comments from Frances & Aviv) & many apt observations by Daniel about the state of psychiatry

www.psychotherapynetworker.org/article/psyc...
Psychiatry Has a New Hero
Psychiatrist Awais Aftab has been inviting the most prominent thinkers in psychiatry to move beyond familiar narratives, embrace complexity, and change the field.
www.psychotherapynetworker.org

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 9d
For the Monday crowd 👇🏽

Reposted by Awais Aftab

eric-reinhart.com
Eric Reinhart @eric-reinhart.com · 10d
As @rachelaviv.bsky.social put it in her interview with @awaisaftab.bsky.social, "the iatrogenic harm story can involve a simplification that, oddly, mimics the chemical imbalance one." This dynamic––to which I also pointed in this essay below––is enormously consequential.
undark.org/2025/08/21/o...

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 11d
In Search of the Unclassified Residuum: Q&A with Rachel Aviv

The author of “Strangers to Ourselves” on diagnostic stories, iatrogenic narratives, explanatory pluralism, humility, and more.

www.psychiatrymargins.com/p/in-search-...
In Search of the Unclassified Residuum: Q&A with Rachel Aviv
“There are stories that save us, and stories that trap us, and in the midst of an illness it can be very hard to know which is which.”
www.psychiatrymargins.com

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 13d
The sexual impact of SSRIs in adolescents is poorly understood and we know even less about instances of protracted sexual difficulties. An important call to action — more research and more mindful clinical practice — by Daniel Bergner in @nytimes.com

www.nytimes.com/2025/11/12/m...
More Teens Are Taking Antidepressants. It Could Disrupt Their Sex Lives for Years.
www.nytimes.com

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 14d
Relatively stable, yes. Personality structure doesn't change dramatically, but the maladaptive behavioral patterns can change. In long-term studies of BPD, for example, more than 80% of people no longer meet criteria over 15-20 years, but their Big 5 traits probably haven't changed that much.

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 14d
>> they respond generally to appropriate clinical care and competent psychotherapy, one that is empathetic, compassionate, and attuned to relational difficulties.

Some relevant thoughts in this post:
www.psychiatrymargins.com/p/borderline...
Borderline Personality and Self-Understanding of Psychopathology
Reflections on BPD and hermeneutical justice
www.psychiatrymargins.com

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 14d
A lot of controversies around BPD are about a) the best way to frame, label, or talk about the relevant experiences and behaviors, b) the misuse, stigmatization, and weaponization of the BPD label. There is no doubt that the experiences exist (regardless of what label you use) and >>

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 15d
Consider, for example, the psychotherapies that have empirical support for borderline personality. They are generally long-term, and they focus on things like transference, mentalization, dialectical behaviors, etc. [The table is from here: psychiatryonline.org/doi/10.1176/...
Table comparing different types of psychotherapies for borderline personality disorder

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 15d
So psychotherapy isn't really a unitary thing. While different types of psychotherapies are generally similar in benefit for depressive episodes or anxiety exacerbations, it appears that the core features of personality disorders are fairly unresponsive to short-term CBT or supportive therapies. >>

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 16d
Re-reading “Acute Religious Experiences” by @dranamorphosis.bsky.social this weekend, and God — what a bloody brilliant book!
A blue book cover with plain colors and the text “Acute Religious Experiences: Madness, Psychosis, and Religious Studies” by Richard Saville-Smith. Bloomsbury

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 17d
The 4 classes:

* Detransitioning with regret (Class A)
*Identity evolutions (Class B)
* Transition ambivalence (Class C)
* Interrupted gender transitions (Class D)

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 17d
“detransition is not a monolithic experience… it can span changes in self-concept, mental health-related factors, gender minority stressors, treatment satisfaction or dissatisfaction, and healthcare access barriers.”

www.psychiatrymargins.com/p/understand...
Understanding Detransition(s) in Transgender Healthcare
A latent class analysis from the DARE study
www.psychiatrymargins.com

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 17d
Understanding Detransition(s) in Transgender Healthcare

The diversity of detransition experiences in the DARE study

Guest post by Kinnon Ross MacKinnon

www.psychiatrymargins.com/p/understand...
Understanding Detransition(s) in Transgender Healthcare
A latent class analysis from the DARE study
www.psychiatrymargins.com

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 17d
The hardest, recurring psychological task of my life has been learning to accept the absurdity of existence, to see ambition and achievement for the false gods they are, and to understand, truly understand, how one can flourish in what looks, from the outside, like mediocrity.

Reposted by Awais Aftab

rwillowfish.bsky.social
Lisa Wallace @rwillowfish.bsky.social · 18d
SSRIs aren't the worst! I also laugh at the notion.

"He doesn’t roll his eyes at people who say psychiatry traumatized them. He thinks a lot of them are telling the truth."
Yes, treatment is full of bad & good encounters.

Sikorav Against the World
www.psychiatrymargins.com/p/sikorav-ag...
Sikorav Against the World
A French psychiatrist’s efforts to do right by his patients brought him into conflict with the medical bureaucracy
www.psychiatrymargins.com

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 19d
Sikorav Against the World

A French psychiatrist’s efforts to do right by his patients brought him into conflict with the medical bureaucracy

www.psychiatrymargins.com/p/sikorav-ag...
Sikorav Against the World
A French psychiatrist’s efforts to do right by his patients brought him into conflict with the medical bureaucracy
www.psychiatrymargins.com

Reposted by Dariusz Galasiński

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 20d
From Here to Humility

Guest post by @bitesizetherapy.bsky.social on the foundational importance of humility in psychotherapy

At every stage, a clinician must be willing to acknowledge that they do not have all the answers

www.psychiatrymargins.com/p/from-here-...
From Here to Humility
At every stage, a clinician must be willing to acknowledge that they do not have all the answers
www.psychiatrymargins.com

Reposted by Awais Aftab

rwillowfish.bsky.social
Lisa Wallace @rwillowfish.bsky.social · 24d
What is good psychotherapy like for me, you ask?

journal drawing:
"The Precious and the Edges"

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 24d
Asterisk Magazine ( @asteriskmag.bsky.social ) — the Books issue in print. The illustrations are beautiful!
A person wearing glasses and a red-and-blue checkered shirt stands against a plain beige wall, holding up a magazine titled asterisk. The cover features a colorful marbled pattern with swirls of blue, orange, red, white, and black, and a black header at the top with white text that includes the title and short preview blurbs.

Reposted by Awais Aftab

alejandrahope.bsky.social
Alejandra Hope @alejandrahope.bsky.social · 28d
Excellent piece yet again, Awais!

I've started to joke that the DSM has unfortunately "escaped containment"– but how much of the responsibility is actually ours as clinicians? If we present certain disorders as lifelong and difficult (or impossible) to treat, who wouldn't take it on as an identity?
In Categories We Live By, psychologist and author Gregory L. Murphy discusses how people tend to believe that certain categories are grounded in something deep, some hidden property that gives the category its identity, even if they cannot say exactly what that something is. Psychologist Woo-kyoung Ahn and her colleagues at Yale have explored how this kind of essentialist thinking plays out in the realm of mental illness. Their studies reveal that laypeople tend to see psychiatric categories as more "real" and more unified than clinicians do. If someone has a particular DSM diagnosis, then they imagine that there must be some internal "thing" responsible for the illness, something that is shared across all cases. Experienced clinicians and professionals, on the other hand, are less likely to think that way. In my own clinical work, I often find myself attempting to deflate the power of these categories. I remind patients not to lean too heavily on the label I'm offering. Not because the label is meaningless, but because the problems it captures are typically imprecise, shifting, deeply contextual. I describe symptom patterns in relation to broader psychological structures, early experiences, temperament, and life stressors. My hope in these conversations with patients is to plant a seed of resistance, to offer an account of suffering that acknowledges complexity, contingency, and context beyond categories. I try to say, in effect: this pattern of symptoms reflects something meaningful about your psychological life, but it doesn't define you. It shouldn't be the scaffold upon which you build your entire self. You're free to acknowledge it, even to use it as a lens, but don't let it confine you. Do not let it determine your story. And yet, I am aware that at a certain level this message is deeply unsatisfying, both to those who see diagnosis as a scaffolding and to those who see it as a trap. In gesturing toward the messy interweaving of temperament and trauma, and softening the solidity of diagnoses, I refuse to indulge our strange masochistic desire for categorical self-confinement. The work of self-definition, especially in the presence of mental illness, is profoundly difficult. The challenge is so enormous that it exhausts us — and DSM categories, imperfect and unsuitable for this task though they are, are nonetheless, for many, a welcome respite from the burden.

Reposted by Awais Aftab

bitesizetherapy.bsky.social
BiteSize Therapy @bitesizetherapy.bsky.social · 29d
“Psychiatric classification as a clinical and scientific project is not designed as a tool for existential self-definition…No diagnostic manual can tell people who they really are.”
- Awais Aftab

A thoughtful, informative, and beautifully written piece 👏🏻

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · 29d
I wrote about the DSM for @asteriskmag.bsky.social ... its historical evolution, scientific disputes, and cultural debates. I’ve tried instead to capture the texture of the rich discussions and the vast commentary that exist around the manual. Enjoy! asteriskmag.substack.com/p/you-arent-...
You Aren't in the DSM
Five editions on, the DSM shoulders more responsibilities than it was ever intended for. How did we get here?
asteriskmag.substack.com

Reposted by Awais Aftab

pessoabrain.bsky.social
PessoaBrain @pessoabrain.bsky.social · Oct 26
If you missed our great discussion with Anil Seth @anilseth.bsky.social on consciousness and its potential biological basis, check it out here!
Very thought provoking, including nuanced discussions on AI consciousness.
Neuroscience & Philosophy Salon:
youtu.be/wZE4_Oa3YA0
Anil Seth discusses consciousness and its potential biological basis
YouTube video by Neuroscience & Philosophy Salon
youtu.be

awaisaftab.bsky.social
Awais Aftab @awaisaftab.bsky.social · Oct 26
Two flavors of critical thought in psychiatry:

- Mental health and illness are fundamentally subjective (derogatory)
vs
- Mental health and illness are fundamentally subjective (complimentary)