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Showing posts from 2020

Primum non Nocere: A Psychiatrist’s Review of “Medicating Normal”

I was lucky to see a screening copy of the documentary Medicating Normal (2020, directors: Lynn Cunningham & Wendy Ractliffe) earlier this weekend, and this post is intended partly as a review and partly as a way of organizing my preliminary thoughts and reactions to it.
As described by the filmmakers: “Medicating Normal is the untold story of what can happen when profit-driven medicine intersects with human beings in distress.” The film is well-made and remarkable. It is engaging and rewards emotional investment.
The focus of the documentary is on the harms of psychiatric medications, the harms these medications can do while one is taking them, and the harms these medications can do when one tries to stop taking them or has stopped taking them. The documentary primarily focuses on the stories and experiences of five individuals who took psychiatric medications and experienced derailment of their lives. There are also interviews with various authors/commentators/experts (which in…

Sola Scriptura and the Scientific Reformation

Recently I've been thinking about Reformation, the 16th century Christian movement in Europe led by Luther. As commonly understood, this movement "posed a religious and political challenge to the Catholic Church and in particular to papal authority, arising from what was perceived to be errors, abuses, and discrepancies by the Catholic Church" (wikipedia).

Prior to Reformation, under the Catholic Church, scripture and tradition were seen as equal, and scriptural interpretation took into account former commentaries as well as Church doctrine and tradition. The Catholic Church had the authority to give authentic interpretation of the Word of God, as reflected in the notion of the Roman magisterium. The common people did not read the Bible or interpret it themselves; they relied on the Church to interpret it for them.

Where others saw infallibility and divine authority, Luther saw corruption. He invoked the notion of sola scriptura, challenging the authority of the clergy …

Bridging Critical and Conceptual Psychiatry: Interview with Mad in America

I was interviewed by Mad in America. We talk about my intellectual development as a psychiatrist, the interview series for Psychiatric Times, my interest in philosophy of psychiatry, and work on “conceptual competence” in psychiatric education. You can listen to the audio as well as the transcript here: https://www.madinamerica.com/2020/07/bridging-critical-conceptual-psychiatry-interview-awais-aftab/

Conversations in Critical Psychiatry

"Conversations in Critical Psychiatry" is my interview series for Psychiatric Times that explores critical and philosophical perspectives in psychiatry and engages with prominent commentators within and outside the profession who have made meaningful criticisms of the status quo.

Following interviews have been published so far. I will continue to update this page as new interviews are published.

1) Conversations in Critical Psychiatry: Allen Frances, MD

2) The Structure of Psychiatric Revolutions: Anne Harrington, DPhil

3) Skepticism of the Gentle Variety: Derek Bolton, PhD

4) Explanatory Methods in Psychiatry: The Importance of Perspectives: Paul R. McHugh, MD

5) Chaos Theory With a Human Face: Niall McLaren, MBBS, FRANZCP

6) The Rise and Fall of Pragmatism in Psychiatry: S. Nassir Ghaemi, MD, MPH
7) Integrating Academic Inquiry and Reformist Activism in Psychiatry: Sandra Steingard, MD & G. Scott Waterman, MD

8) Social Constructionism Meets Aging and Dementia: Peter W…

From “What is disorder?” to Heidegger & Explanatory Pluralism: A Discussion with James Barnes

James Barnes is a psychotherapist, mental health advocate, and writer. He lives in Exeter in the UK. He is on twitter: @psychgeist52
Discussion Background
This discussion started on Twitter in the context of the last blogpost in which Mark Ruffalo and Ron Pies discuss their views on psychiatric diagnoses and on the definition of “disorder”.
James Barnes objected that a non-essentialist, pragmatic definition of disorder misses the entire point of the term “disorder” or “disease”, which for him is to discriminate an empirical object of/in the organism, as it does in the vast majority of cases of unquestioned physical disorders.
I responded by saying it is possible to define disease/disorder is many different ways, that each definition has its internal logic, and each has pros and cons, and different implications. A common goal of most definitions is to try to capture the everyday use of this term in general medicine, but other definitions may not care for this goal. So, I don't find …

An Exchange with Ruffalo & Pies: More on Diagnosis & Diagnostic Explanation

The following are comments from Mark L. Ruffalo, D.Psa., L.C.S.W and Ronald W. Pies, M.D. in response to my previous blogpost: "Can Symptoms Be Caused by Descriptive Syndromes? An Analysis".
As a reminder, my blogpost was written in the context of an article by Ruffalo and Pies ("What Is Meant by a Psychiatric Diagnosis?") that had been written in response to an article by Jonathan Shedler, Ph.D ("A Psychiatric Diagnosis Is Not a Disease"). Both these article were in Psychology Today.
I will post the comments from Ruffalo and Pies, followed by brief comments from me.
COMMENTS FROM MARK RUFFALO AND RONALD PIES
Dear Awais,
Thank you for the opportunity to respond to your thoughtful comments on our article in Psychology Today, and on the broader—and very complex—issues we are all raising.
Our position, roughly speaking, could be summed up in three basic principles: 1) Avoid definitional essentialism 2) Embrace clinical pragmatism; and 3) Respect ordinary lan…

Can Symptoms Be Caused by Descriptive Syndromes? An Analysis

In this post I want to examine the question of whether it makes sense to say that a patient’s anxiety is caused by ‘Generalized Anxiety Disorder’.
Jonathan Shedler argues that it doesn’t. Mark Ruffalo and Ron Pies argue that it does.
This is not a specific response to either, but simply a clarification of my own views.
1) The first thing I want to do is point to Hane Maung’s brilliant philosophical paper “To what do psychiatric diagnoses refer? A two-dimensional semantic analysis of diagnostic terms” (2016). Maung argues with great philosophical sophistication that reference of diagnostic terms in psychiatry can have two meanings or two intentions
“a diagnosis has a pre-theoretical mode of presentation that characterises the 1-intension, and an underlying structure that is discovered a posteriori and determines the 2-intension…. In the case of a diagnosis, the mode of presentation is the clinical manifestation and the underlying structure is the disease process that is responsible for the …