Awais Aftab

Writer at Psychiatry at the Margins

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Articles

The Medication Life and the Moral Career

4 weeks ago | psychiatrymargins.com | Awais Aftab

Among the five letters received and published by the New York Times in response to my op-ed on antidepressants, my favorite is the one by the author and psychotherapist Daniel Smith. The version published by NYT is highly condensed and Smith was kind enough to share with me the full text of the letter he had originally submitted, which I am happy to publish here (along with some comments and reflections prompted by it).
Why Did Evolution Leave Us Vulnerable to Mental Disorders? A Q&A with Randolph Nesse

1 month ago | psychiatrymargins.com | Awais Aftab

Randolph M. Nesse is a founder of the fields of evolutionary medicine and evolutionary psychiatry.
Profiled in Lancet Psychiatry

1 month 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.
The Evolutionary Genetics of Schizophrenia

1 month 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.
Schizophrenia Is the Price We Pay for Minds Poised Near the Edge of a Cliff

1 month 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.
When It Comes to SSRIs, Are Our Only Choices “Safe & Effective” or “More Dangerous Than Heroin”?

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.
Emil du Bois-Reymond & Ignorance in Science: Interview with Gabriel Finkelstein

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.
What Kennedy Gets Right, And Wrong, About Antidepressants

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.
American Psychiatry in the Shadow of MAHA and MAGA

2 months 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.
People Are Still Stumbling From One Misguided Narrative About the Medical Model to Another (ADHD Edition)

2 months 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.