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3 weeks ago | 
psychiatrymargins.com | Awais Aftab
Randolph M. Nesse is a founder of the fields of evolutionary medicine and evolutionary psychiatry.
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3 weeks ago | 
psychiatrymargins.com | Awais Aftab
The Lancet Psychiatry, a leading international psychiatry journal, has published a profile on me in their latest issue, in which I am described as “one of the discipline’s foremost public intellectuals.” The profile mentions this Substack, Psychiatry at the Margins, as well as my Psychiatric Times series “Conversations in Critical Psychiatry” and the Oxford University Press book adaptation.
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3 weeks ago | 
psychiatrymargins.com | Awais Aftab
Schizophrenia Is the Price We Pay for Minds Poised Near the Edge of a CliffSince publication of the post “Schizophrenia Is the Price We Pay for Minds Poised Near the Edge of a Cliff,” friends and readers have reached out to me to highlight various problems with this hypothesis. It is perhaps not surprising at all that scientific details are complicated and recent research findings have cast doubt on some older reports.
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4 weeks ago | 
psychiatrymargins.com | Awais Aftab
This post discusses cliff-edged fitness functions by Randolph Nesse (psychiatrist and one of the founders of evolutionary medicine) and the 2024 paper, “The cliff edge model of the evolution of schizophrenia: Mathematical, epidemiological, and genetic evidence,” by Philipp Mitteroecker and Giuseppe Pierpaolo Merola. If you are a regular reader of this newsletter, and it deepens your intellectual life, consider a paid subscription to support this effort.
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1 month ago | 
psychiatrymargins.com | Awais Aftab
In an Opinion guest essay for the New York Times (May 3, 2024) — titled variously as “Prozac Is Nearly 40 Years Old. Why Are There Still Unanswered Questions?” “Harm From Antidepressants Is Real.
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1 month ago | 
psychiatrymargins.com | Awais Aftab |Josh Richardson
Readers of Psychiatry at the Margins will remember Joshua Richardson from his reviews of the ‘Too Mad to be True’ conferences. Several years ago, Josh introduced me to Emil du Bois-Reymond and the Latin maxim “ignoramus et ignorabimus,” (“we are ignorant and we will remain ignorant”), and Josh treats us now to an interview with the historian Gabriel Finkelstein.
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1 month ago | 
nytimes.com | Awais Aftab
Like every psychiatrist, I have patients for whom antidepressants are transformative, even lifesaving. But I also see a messier, less advertised side of these medications. There are patients with sexual side effects that they hadn't known could be caused by their antidepressants because previous doctors never warned them.
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1 month ago | 
psychiatrymargins.com | Awais Aftab
Sociopolitical dysfunction and pseudoscientific populism in the US have come for psychiatry, as they have for much of academia and medicine. Just as sepsis affects all organs of a body, no social institution can function properly in a septic society. The predicament of American medicine is multi-layered, and failures of the healthcare system have played no small part in the etiogenesis.
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1 month ago | 
psychiatrymargins.com | Awais Aftab
People Are Stumbling From One Misguided Narrative About the Medical Model to AnotherThe story “Have We Been Thinking About A.D.H.D. All Wrong?” in the New York Times Magazine by Paul Tough (April 13, 2025) has generated intense discussion over this past week.
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1 month ago | 
psychiatrymargins.com | Awais Aftab
Traditional antidepressants that act via serotonin and other monoamines, such as SSRIs, require several weeks to show substantial symptomatic improvement, and it has been a source of frustration for clinicians and patients from the very beginning. The delayed onset led to the search for and the development of antidepressant medications, such as ketamine and brexanolone, that begin to show meaningful effects within hours and days, and that act via mechanisms that go beyond the monoamine system.
