On 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...

On 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...

Letter 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/...

The Dimensional Turn in Psychopathology: Q&A with Robert Krueger (Jan 2025) www.psychiatrymargins.com/p/the-dimens...

New and beautiful OUP volume on dimensional models of psychopathology

Check out the PPP special issue on philosophy of Hierarchical Taxonomy of Psychopathology (HiTOP) muse.jhu.edu/issue/56979

@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...

Some Predictions About the Future of “Withdrawal Studies” What we talk about when we talk about antidepressant withdrawal www.psychiatrymargins.com/p/some-predi...

Some Predictions About the Future of “Withdrawal Studies” What we talk about when we talk about antidepressant withdrawal www.psychiatrymargins.com/p/some-predi...

Explaining 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

Finally we are discarding the imaginary boundaries of “schizophrenia” and “bipolar” … “DSM categories did not correspond to distinct biological entities. Instead, they lined up along a continuum of severity that appears across multiple bio-factor domains…”

The Brain Architecture of Schizophrenia-Bipolar Psychosis Spectrum In my new post today, I discuss the B-SNIP biotypes of psychosis and how I make sense of them www.psychiatrymargins.com/p/the-brain-...

The Brain Architecture of Schizophrenia-Bipolar Psychosis Spectrum In my new post today, I discuss the B-SNIP biotypes of psychosis and how I make sense of them www.psychiatrymargins.com/p/the-brain-...

Mixed Bag #26: Darby Saxbe on the Science of Fatherhood @darbysaxbe.bsky.social @awaisaftab.bsky.social

Mixed Bag #26: Darby Saxbe on the Science of Fatherhood @darbysaxbe.bsky.social explores the topic via a book, a concept, a person, an article, and a surprise item www.psychiatrymargins.com/p/mixed-bag-...

Why Did Evolution Leave Us Vulnerable to Mental Disorders? A Q&A with Randolph Nesse “Individuals with disorders often have advantages, but that does not make the disorder an adaptation.” [May 2025] www.psychiatrymargins.com/p/why-did-ev...

Adding a firey quote of this type about the "Biopsychosocial model" of psychiatric conditions, taken from an interview of Paul R. McHugh by @awaisaftab.bsky.social. "Sophistry!" www.psychiatrictimes.com/view/explana...

The Ground Beneath the Clinic On the scope of medical authority www.psychiatrymargins.com/p/the-ground...

The Ground Beneath the Clinic On the scope of medical authority www.psychiatrymargins.com/p/the-ground...

I look forward to attending the annual meeting of the Association for the Advancement of Philosophy and Psychiatry at UT Dallas this coming week, where I'll be presenting (Tuesday AM) on “What Kinds of Things are B-SNIP Biotypes of Psychosis?” values.utdallas.edu/2026/03/25/p...

This is important work. I argue that the pluralism Awais refers to is specifically biologically grounded in the PAG precognitive affective signals that Panksepp names via Solms on the subjective/idiographic level and physical laws on the objective/nomothetic level.

A Pluralist’s Quarrels with “Critical Psychiatry” Where do I stand? www.psychiatrymargins.com/p/a-pluralis...

My gratitude to American Psychiatric Association for the 2026 Distinguished Service Award for “public scholarship that bridges clinical science, philosophy, and thoughtful public discourse.”

This is an astounding piece: beautifully written, highly accessible, and a model of great science communication. It definitely resonates with me, for a variety of professional and personal reasons. Thank you @awaisaftab.bsky.social for writing it, much appreciated.

I wish that more mental health clinicians would implement the paradigm outlined in this phenomenal piece. Instead, I have found too many use a pin the tail on the donkey approach to diagnosis and case conception.

The always great @awaisaftab.bsky.social on the nature of psychiatric diagnosis.

This. Go read this. @awaisaftab.bsky.social cuts right to the core of the Bergner nytimes article. Much better than I ever could.

This, by @awaisaftab.bsky.social, is excellent. It deserves to be agenda-setting. www.nytimes.com/2026/05/11/o...

💯

"Furthermore, whatever MAHA psychiatry says, the Trump administration’s broader agenda has been to weaken the public health and social safety net infrastructure that any humane response to mental illness depends on. This is why I hesitate to endorse even the sensible-sounding parts of MAHA agenda."

The Szaszian Heart of MAHA Psychiatry "... whatever MAHA psychiatry says, the Trump administration’s broader agenda has been to weaken the public health & social safety net infrastructure that any humane response to mental illness depends on." Awais Aftab @awaisaftab.bsky.social May 16, 2026

The Szaszian Heart of MAHA Psychiatry Moderate-sounding entry points to an unpopular agenda www.psychiatrymargins.com/p/the-szaszi...

"Each of these labels can capture something useful and inform treatment options, but none of them do justice to the dimensional and dynamic nature of mental illness."

Beautiful piece by Awais. Money quote below. My one concern is that many psychiatrists do not in fact mean what Awais means when they say "you have ADHD". They mean it in exactly the same way one says "you have liver cancer". And it's very harmful for mental health science and practice.

Clear, compassionate, concise, and critical. Fantastic writing as usual by @awaisaftab.bsky.social. "Each of these labels can capture something useful and inform treatment options, but none of them do justice to the dimensional and dynamic nature of mental illness." www.nytimes.com/2026/05/11/o...

I’ll be giving this article to every client who asks me this question henceforth.

When patients ask, “What disorder do I really ‘have’?” the honest answer is usually more interesting and messier than a single diagnostic label. I wrote for the @nytimes.com on what I wish people understood about diagnoses and the nature of mental health problems. www.nytimes.com/2026/05/11/o...

Very good description of psychiatric diagnoses from @awaisaftab.bsky.social 👏👏👏 www.nytimes.com/2026/05/11/o...

from @awaisaftab.bsky.social

When patients ask, “What disorder do I really ‘have’?” the honest answer is usually more interesting and messier than a single diagnostic label. I wrote for the @nytimes.com on what I wish people understood about diagnoses and the nature of mental health problems. www.nytimes.com/2026/05/11/o...

Make Deprescribing Boring On the ASCP Consensus Statements and the MAHA Discourse www.psychiatrymargins.com/p/make-depre...

Immense respect for Awais. His substack is great

Make Deprescribing Boring On the ASCP Consensus Statements and the MAHA Discourse www.psychiatrymargins.com/p/make-depre...

Notes from a South American Psychiatrist on the Future DSM Description and discrimination in fragile health systems Guest post by Gonzalo Amador Rivera www.psychiatrymargins.com/p/notes-from...

Chuffed to finally punblish this with @awaisaftab.bsky.social et al Attitudes towards conceptual and philosophical issues in psychiatry and psychiatric education: A survey of US and UK trainees journals.sagepub.com/doi/10.1177/...

A fascinating reading, as always.

Twilight of the Psychopharmacologists A Review of “Psychopharmacology Reconsidered” and the collapse of diagnosis-centered psychopharmacology www.psychiatrymargins.com/p/twilight-o...

Reposting for the Monday crowd

Their Desire Is the Desire of the Other Flash fiction inspired by Terry Bisson and Jacques Lacan www.psychiatrymargins.com/p/their-desi...

Their Desire Is the Desire of the Other Flash fiction inspired by Terry Bisson and Jacques Lacan www.psychiatrymargins.com/p/their-desi...