Reposted by Awais AftabHermione Gingold @hermionegingold.bsky.social · 29/09/2026Phew! This post hit the nail on the head. 012
Reposted by Awais AftabHaydon @haydonmp.bsky.social · 29/09/2026Really important and useful article. 2143
Awais Aftab @awaisaftab.bsky.social · 29/09/2026I am doing a series of articles (“Therapeutic Window”) for the Science desk at The New York Times. The first article is about whether ADHD is better understood as a disorder of “attention” or something else: www.nytimes.com/2026/09/29/s...nytimes.comWhat If A.D.H.D. Isn’t About Attention at All? (Gift Article)Evidence suggests that it really affects what psychiatrists like me call sustained engagement — an important difference in understanding how to think about the condition. 13210
Reposted by Awais AftabLaura Routh @laurarouth.bsky.social · 26/09/2026“The system is organized around scarcity of attention and time. It is relatively easy to ask for and be prescribed medications, but quite difficult to see a physician who actually cares and listens and thoughtfully attends to diagnostic work-up and treatment risks and patient concerns.” 031
Awais Aftab @awaisaftab.bsky.social · 26/09/2026I Believe in a Radical Abundance of Relational Care “The more I practice, the more I believe that attention is the rarest and purest form of clinical generosity.” www.psychiatrymargins.com/p/i-believe-...psychiatrymargins.comI Believe in a Radical Abundance of Relational CareI am wary of movements that focus on a subtractive agenda, one whose primary ambition is to take things away from people. 2163
Reposted by Awais AftabLaura Routh @laurarouth.bsky.social · 19/09/2026In supporting a loved one with a mental illness, I’m painfully acquainted with, and appreciate, what @awaisaftab.bsky.social describes regarding the harms and benefits of psychiatric medication, now both a necessity and godsend for my loved one, and us. Do I wish for something better? You bet. 063
Reposted by Awais AftabJoshua Richardson @schizosemia.bsky.social · 19/09/2026“I feel like the psychiatric profession messed up big in the tone it took when it came to public outreach and mental health awareness efforts. We communicated to people that we have stuff figured out, that we know what to do.” 0104
Reposted by Awais AftabAlejandra Hope @alejandrahope.bsky.social · 19/09/2026As always, I deeply appreciate Awais's honesty re psychiatric prescribing, and I so wish I experienced more of that honesty from psychiatrists and other clinicians in my own care. 061
Awais Aftab @awaisaftab.bsky.social · 19/09/2026“Psychiatric treatment is often enough a frustrating affair, for the patient, for the clinician, for the caregivers, basically for everyone involved…” On imperfect tools www.psychiatrymargins.com/p/maybe-dont...psychiatrymargins.comMaybe Don’t Ask Your Doctor if Zoloft Is Right for YouOn imperfect tools 1178
Awais Aftab @awaisaftab.bsky.social · 12/09/2026The Lawsuit That Came to Symbolize the Fall of Psychoanalytic Psychiatry: Eric Caplan on Osheroff v. Chestnut Lodge www.psychiatrymargins.com/p/the-lawsui...psychiatrymargins.comThe Lawsuit That Came to Symbolize the Fall of Psychoanalytic Psychiatry: Eric Caplan on Osheroff v. Chestnut LodgeEric Caplan is a historian of American psychiatry and the author of "When Healing Harms" 1123
Reposted by Awais AftabColette Delawalla, PhD @cdelawalla.bsky.social · 06/09/2026Tons of ~discourse~ about AOC taking meetings with voters in the MAHA block. I’m about to sit down and write all my thoughts down, but in the mean time, I wrote extensively about my experience trying to survive a horrid pregnancy & I get the vulnerability. www.psychiatrymargins.com/p/i-am-train...psychiatrymargins.comI Am Trained to Diagnose Depression, Yet I Overlooked My Own Amidst a Rock Bottom PregnancyGuest post by Colette Delawalla 4288
Awais Aftab @awaisaftab.bsky.social · 06/09/2026Depression & anxiety seem common & familiar but few can appreciate the psychopathological depths possible. Once in a while I come across an Omega level neurosis in the clinic, & it is like witnessing something alien & ancient, a horror & dread with the gravity of a neutron star… 0121
Awais Aftab @awaisaftab.bsky.social · 06/09/2026Defending the Mechanistic Plausibility of Protracted and Delayed Antidepressant Withdrawal Guest post by Daniel Cohrs www.psychiatrymargins.com/p/defending-...psychiatrymargins.comDefending the Mechanistic Plausibility of Protracted and Delayed Antidepressant WithdrawalGuest post by Daniel Cohrs 042
Reposted by Awais AftabAwais Aftab @awaisaftab.bsky.social · 04/09/2026Postpartum Psychosis and Diagnostic Sclerosis The DSM needs postpartum psychosis more than postpartum psychosis needs the DSM www.psychiatrymargins.com/p/postpartum...psychiatrymargins.comPostpartum Psychosis and Diagnostic SclerosisThe DSM needs postpartum psychosis more than postpartum psychosis needs the DSM 152
Reposted by Awais AftabDr K WILDSCHUT @drkwildschut1984.bsky.social · 04/09/2026Postpartum Psychosis is a well known clinical syndrome, yet not firmly categorised as a disease in DSM and perhaps there’s the issue that this trial reveals. Timely blog here to elaborate on the matter, by @awaisaftab.bsky.social open.substack.com/pub/awaisaft...open.substack.comPostpartum Psychosis and Diagnostic SclerosisThe DSM needs postpartum psychosis more than postpartum psychosis needs the DSM 2145
Awais Aftab @awaisaftab.bsky.social · 04/09/2026Postpartum Psychosis and Diagnostic Sclerosis The DSM needs postpartum psychosis more than postpartum psychosis needs the DSM www.psychiatrymargins.com/p/postpartum...psychiatrymargins.comPostpartum Psychosis and Diagnostic SclerosisThe DSM needs postpartum psychosis more than postpartum psychosis needs the DSM 152
Awais Aftab @awaisaftab.bsky.social · 29/08/2026Lindsay Clancy and the Dream of a World Beyond the Insanity Defense The absurdity of mad versus bad www.psychiatrymargins.com/p/lindsay-cl...psychiatrymargins.comLindsay Clancy and the Dream of a World Beyond the Insanity DefenseThe absurdity of mad versus bad 141
Reposted by Awais AftabAmerican Academy of Child & Adolescent Psychiatry @aacap.bsky.social · 24/08/2026Psychiatry is under more public scrutiny than it has seen in a generation. In our #AACAP26 Presidential Interview, Drs. Walkup and @awaisaftab.bsky.social will tackle diagnostic validity, deprescribing, and the future of psychiatric classification and treatment. aacap.confex.com/aacap/2026/m... 032
Awais Aftab @awaisaftab.bsky.social · 23/08/2026What the New York AOT Evaluation Team Actually Found New York State Legislature ordered a comprehensive independent study of Kendra’s Law in 2022. The results have now been published and are being misrepresented. Guest post by Nev Jones & PathLab www.psychiatrymargins.com/p/setting-th...psychiatrymargins.comSetting the Record Straight: What the New York AOT Evaluation Team Actually FoundNew York State Legislature ordered a comprehensive independent study of Kendra’s Law in 2022. The results have now been published and are being misrepresented. 010
Awais Aftab @awaisaftab.bsky.social · 21/08/2026Erotic Countertransference Disclosure & the Collapse of the “as-if” Relationship Some psychotherapists argue that erotic countertransference disclosures may serve a therapeutic function... but what are the pitfalls? Guest post by @frannyfanny.bsky.social www.psychiatrymargins.com/p/erotic-cou...psychiatrymargins.comErotic Countertransference Disclosure and the Collapse of the “as-if” RelationshipSome psychotherapists argue that erotic countertransference disclosures may serve a therapeutic function... but what are the pitfalls? 053
Reposted by Awais AftabMr. Chimpanzy @cyanescens.bsky.social · 19/08/2026Great article (if you’re interested in such things) that I missed at the time: 021
Awais Aftab @awaisaftab.bsky.social · 15/08/2026Notes on Freud and Cocaine Sometimes cocaine use is just cocaine use, and sometimes it is a prelude to the development of psychoanalysis... www.psychiatrymargins.com/p/notes-on-f...psychiatrymargins.comNotes on Freud and CocaineSometimes cocaine use is just cocaine use, and sometimes it is a prelude to the development of psychoanalysis... 160
Reposted by Awais AftabShane Glackin @eltorosolo.bsky.social · 10/08/2026The very excellent @awaisaftab.bsky.social had an excellent piece on the difficulties of deprescription just a couple of days ago: www.psychiatrymargins.com/p/psychiatri...psychiatrymargins.comPsychiatric Deprescribing as a Wicked ProblemProblems that resist definitive articulation 022
Reposted by Awais AftabAlex Mendelsohn, PhD @alexmendelsohn.bsky.social · 10/08/2026Footnotes from the Margins I love footnotes, so I'm sharing my favs Steve Hyman (writing in @awaisaftab.bsky.social Psychiatry at the Margins) introduces a delightfully succinct word describing a complex idea. www.psychiatrymargins.com/p/a-note-fro... 011
Reposted by Awais AftabSofia Jeppsson @jeppsson.bsky.social · 09/08/2026www.cambridge.org/core/journal... Important piece by @awaisaftab.bsky.social . Whether it's better to stay on one's meds or come off them is a complex and value-laden question. Psychiatry must acknowledge this instead of labeling every desire to quit as "lack of insight" and force compliance.cambridge.orgClinical guidelines addressing complex and ‘wicked’ problems | BJPsych Bulletin | Cambridge CoreClinical guidelines addressing complex and ‘wicked’ problems 072
Awais Aftab @awaisaftab.bsky.social · 08/08/2026Psychiatric Deprescribing as a Wicked Problem www.psychiatrymargins.com/p/psychiatri...psychiatrymargins.comPsychiatric Deprescribing as a Wicked ProblemProblems that resist definitive articulation 351
Reposted by Awais AftabAwais Aftab @awaisaftab.bsky.social · 01/08/2026Adiposity by Self-Report What if obesity were invisible in the same way as ADHD is? www.psychiatrymargins.com/p/adiposity-...psychiatrymargins.comAdiposity by Self-ReportIf obesity were like ADHD 265
Awais Aftab @awaisaftab.bsky.social · 01/08/2026Adiposity by Self-Report What if obesity were invisible in the same way as ADHD is? www.psychiatrymargins.com/p/adiposity-...psychiatrymargins.comAdiposity by Self-ReportIf obesity were like ADHD 265
Reposted by Awais Aftabenlightenededu.bsky.social @enlightenededu.bsky.social · 25/07/2026The Principle of Rumpelstiltskin: Psychiatrists & Witchdoctors Torrey on the magic of the right word Awais Aftab 25 July 2026 @awaisaftab.bsky.socialopen.substack.comThe Principle of Rumpelstiltskin: Psychiatrists and WitchdoctorsTorrey on the magic of the right word 021
Awais Aftab @awaisaftab.bsky.social · 25/07/2026The Principle of Rumpelstiltskin: Psychiatrists and Witchdoctors On how E. Fuller Torrey articulated the Rumpelstiltskin effect as a principle of psychotherapy a half century before @alanlevinovitz.bsky.social and I did www.psychiatrymargins.com/p/the-princi...psychiatrymargins.comThe Principle of Rumpelstiltskin: Psychiatrists and WitchdoctorsTorrey on the magic of the right word 151
Awais Aftab @awaisaftab.bsky.social · 19/07/2026The Future of Withdrawal Studies Is Already Written Guest post by Adele Framer in response to my earlier post on predictions about the future of withdrawal studies www.psychiatrymargins.com/p/the-future...psychiatrymargins.comThe Future of Withdrawal Studies Is Already WrittenGuest post by Adele Framer 022
Awais Aftab @awaisaftab.bsky.social · 11/07/2026Forever Cousins: Relationships With My Voices “If I thought my voice was nothing more than random, psychotic noise, then that’s all she ever would have been.” Guest post by Amanda Peery-Wolf www.psychiatrymargins.com/p/forever-co...psychiatrymargins.comForever Cousins: Relationships with My Voices“If I thought my voice was nothing more than random, psychotic noise, then that’s all she ever would have been.” 0113
Reposted by Awais AftabAlejandra Hope @alejandrahope.bsky.social · 05/07/2026As always, excellent thoughts from Awais on the (mostly unfortunate) state of affairs in psychiatric practice these days: 272
Reposted by Awais Aftabenlightenededu.bsky.social @enlightenededu.bsky.social · 05/07/2026"Most psychiatrists do not need to be psychotherapists (I am not), but they do still need to be attuned to the psychological complexity of the whole person & the relational aspects of psychiatric treatment." 5 July 2026 Psychiatry at the Margins Awais Aftab @awaisaftab.bsky.socialopen.substack.comThe Fantasy of Being “Just” a Psychiatric PrescriberThe job of containment and metabolism 032
Awais Aftab @awaisaftab.bsky.social · 05/07/2026The Fantasy of Being “Just” a Psychiatric Prescriber The job of containment and metabolism www.psychiatrymargins.com/p/the-fantas...psychiatrymargins.comThe Fantasy of Being “Just” a Psychiatric PrescriberThe job of containment and metabolism 252
Reposted by Awais AftabAdam DeVille @adamdeville.bsky.social · 04/07/2026Dr Aftab again raising crucial questions in psychiatric nosology. 141
Reposted by Awais AftabAwais Aftab @awaisaftab.bsky.social · 03/07/2026What Psychosis Classification Can Learn from Epilepsy Classification The Future of “Schizophrenia” www.psychiatrymargins.com/p/what-psych...psychiatrymargins.comWhat Psychosis Classification Can Learn from Epilepsy ClassificationThe Future of “Schizophrenia” 0103
Reposted by Awais AftabLaura Routh @laurarouth.bsky.social · 04/07/2026“DSM-5 schizophrenia, however, is an awkward construct that cannot give up chronicity and cognitive impairment but also cannot commit to it.” It has always felt clumsy to me. Fascinating post! 043
Reposted by Awais Aftabenlightenededu.bsky.social @enlightenededu.bsky.social · 04/07/2026What Psychosis Classification Can Learn from Epilepsy Classification The Future of "Schizophrenia" 3 July 2026 Psychiatry at the Margins Awais Aftab @awaisaftab.bsky.socialopen.substack.comWhat Psychosis Classification Can Learn from Epilepsy ClassificationThe Future of “Schizophrenia” 021
Awais Aftab @awaisaftab.bsky.social · 03/07/2026What Psychosis Classification Can Learn from Epilepsy Classification The Future of “Schizophrenia” www.psychiatrymargins.com/p/what-psych...psychiatrymargins.comWhat Psychosis Classification Can Learn from Epilepsy ClassificationThe Future of “Schizophrenia” 0103
Reposted by Awais AftabAwais Aftab @awaisaftab.bsky.social · 20/06/2026On Suicidality Guest post by Sorbie Richner “Suicidality has been a main character in my life since I was a little kid. I started covertly making it other people’s problem starting when I was about 9 years old by externalizing it as rage…” www.psychiatrymargins.com/p/on-suicida...psychiatrymargins.comOn SuicidalityGuest post by Sorbie Richner 185
Awais Aftab @awaisaftab.bsky.social · 20/06/2026On Suicidality Guest post by Sorbie Richner “Suicidality has been a main character in my life since I was a little kid. I started covertly making it other people’s problem starting when I was about 9 years old by externalizing it as rage…” www.psychiatrymargins.com/p/on-suicida...psychiatrymargins.comOn SuicidalityGuest post by Sorbie Richner 185
Awais Aftab @awaisaftab.bsky.social · 19/06/2026Letter to the editor of the American Journal of Psychiatry, making a case that the future DSM should have an independent domain of psychological factors alongside social context, candidate biomarkers, and transdiagnostic features. psychiatryonline.org/doi/10.1176/... 185
Awais Aftab @awaisaftab.bsky.social · 19/06/2026The Dimensional Turn in Psychopathology: Q&A with Robert Krueger (Jan 2025) www.psychiatrymargins.com/p/the-dimens...psychiatrymargins.comThe Dimensional Turn in Psychopathology: Q&A with Robert KruegerDistinguished McKnight University Professor at the University of Minnesota 020
Awais Aftab @awaisaftab.bsky.social · 18/06/2026New and beautiful OUP volume on dimensional models of psychopathology 1101
Awais Aftab @awaisaftab.bsky.social · 16/06/2026Check out the PPP special issue on philosophy of Hierarchical Taxonomy of Psychopathology (HiTOP) muse.jhu.edu/issue/56979 1152
Reposted by Awais AftabAlex Mendelsohn, PhD @alexmendelsohn.bsky.social · 15/06/2026@awaisaftab.bsky.social sits between the critical and commendatory aspects of psychiatry, much to the annoyance of some of his new (ex-)subscribers... #FootnotesFromTheMargins www.psychiatrymargins.com/p/reflection... 071
Reposted by Awais AftabAwais Aftab @awaisaftab.bsky.social · 13/06/2026Some Predictions About the Future of “Withdrawal Studies” What we talk about when we talk about antidepressant withdrawal www.psychiatrymargins.com/p/some-predi...psychiatrymargins.comSome Predictions About the Future of “Withdrawal Studies”What we talk about when we talk about antidepressant withdrawal 062
Awais Aftab @awaisaftab.bsky.social · 13/06/2026Some Predictions About the Future of “Withdrawal Studies” What we talk about when we talk about antidepressant withdrawal www.psychiatrymargins.com/p/some-predi...psychiatrymargins.comSome Predictions About the Future of “Withdrawal Studies”What we talk about when we talk about antidepressant withdrawal 062
Reposted by Awais Aftabkoenfucius @koenfucius.bsky.social · 10/06/2026Explaining schizophrenia, anorexia or autism by proposing ways they might offer advantages is tempting but almost always wrong. Diseases are not adaptations shaped by natural selection. @awaisaftab.bsky.social talks evolutionary psychiatry with Randolph Nesse: buff.ly/xK0itkD 231