Psychiatry at the Margins | Awais Aftab | Substack

Exploring critical, philosophical, and scientific debates in psychiatric practice and the psy-sciences. Click to read Psychiatry at the Margins, by Awais Aftab, a Substack publication with tens of thousands of subscribers.

How to spot a psychopath: ‘It’s like the difference between a domestic cat and a wild cat’

People with persistent predatory personalities cause an inordinate amount of pain. Recently, our shared understanding of them has grown – and it could help protect us

Mental Wealth

TL;DR • When it comes to mental health, our society approaches it like we did with physical health 50 years ago. We only think about it when something goes wrong. • To the wider public, mental heal…

Madness and Enterprise: Psychiatry, Economic Reason, and the Emergence of Pathological Value

Uncovers a powerful relationship between pathology and money: beginning in the nineteenth century, the severity of mental illness was measured against a patient’s economic productivity.  Madness and Enterprise reveals the economic norms embedded within psychiatric thinking about mental illness in the North Atlantic world. Over the course of the nineteenth century, various forms of madness were subjected to a style of psychiatric reasoning that was preoccupied with money. Psychiatrists across Western Europe and the United States attributed financial and even moral value to an array of pathological conditions, such that some mental disorders were seen as financial assets and others as economic liabilities. By turning to economic conduct and asking whether potential patients appeared capable of managing their financial affairs or even generating wealth, psychiatrists could often bypass diagnostic uncertainties about a person’s mental state. Through an exploration of the intertwined histories of psychiatry and economic thought, Nima Bassiri shows how this relationship transformed the very idea of value in the modern North Atlantic, as the most common forms of social valuation—moral value, medical value, and economic value—were rendered equivalent and interchangeable. If what was good and what was healthy were increasingly conflated with what was remunerative (and vice versa), then a conceptual space opened through which madness itself could be converted into an economic form and subsequently redeemed—and even revered.

Who listens when mental health struggles disrupt daily life?

Ask a Bangladeshi newspaper reader to picture a mental health story. Perhaps a psychiatrist’s quote comes to mind, a helpline number, or a headline about a student’s death.

Opinion | To Make the World Better, Think Small (Published 2016)

It is easy to become numb to suffering. Feeling empathy for individual victims can overcome the numbness.

Dopamine Nation — Anna Lembke, MD

In Dopamine Nation, Dr. Anna Lembke, psychiatrist and author, explores the exciting new scientific discoveries that explain why the relentless pursuit of pleasure leads to pain.

How Bad Are Things?

One “advantage” of working in psychiatry is getting a window into an otherwise invisible world of really miserable people. I work in a wealthy, mostly-white college town consistently ra…

Mental Health, The Bangladeshi State, Culture, and Liberalism — miftah

That for Bangladeshi liberals, “the culture” and “the people” are boogeymen that shield capitalism and the state from any criticism, becomes the most ironic when the topic is mental health, and the impulse of these people is to blame mentally ill people for not seeking help.

The New Wounded

This book addresses the issue of trauma and psychic wounds to stage a confrontation between psychoanalysis and contemporary neurobiology. In so doing, it reevaluates the brain as an organ that is not separated from psychic life but rather appears as its very locus. A philosophical approach of the “new wounded” (brain lesion patients) forms the matter of the confrontation.

The Wretched of the Earth

A distinguished psychiatrist from Martinique who took p…

Effects of Extreme Ritual Practices on Psychophysiological Well-Being

Extreme ritual practices involving pain and suffering pose significant risks such as injury, trauma, or infection. Nonetheless, they are performed by millions of people around the world and are often culturally prescribed remedies for a variety of maladies, and especially those related to mental health. What is the actual impact of these practices on health? Combining ethnographic observations and psychophysiological monitoring, we investigated outcomes of participation in one of the world’s most extreme rituals, involving bodily mutilation and prolonged suffering. Performance of this physically demanding ordeal had no detrimental effects on physiological health and was associated with subjective health improvements, and these improvements were greater for those who engaged in more intense forms of participation. Moreover, individuals who experienced health problems and/or were of low socioeconomic status sought more painful levels of engagement. We suggest two potential mechanisms for these effects: a bottom-up process triggered by neurological responses to pain and a top-down process related to increased social support and self-enhancement. These mechanisms may buffer stress-induced pressures and positively affect quality of life. Our results stress the importance of traditional cultural practices for coping with adversity, especially in contexts where psychiatric or other medical interventions are not widely available.

Philosophy Officer on Instagram: "I AM SO EMOTIONALLY MATURE I have massive problems with this term. Most people would say it means something along the lines of: the ability to understand, process, regulate or communicate emotions in a healthy way. Now the issue is that all of the terms you use to explain it leave so much room for interpretation the definition becomes almost vacuous. To understand an emotion means to know what caused it? To know the impact it has on you physiologically? To understand how it affects your cognition? To know how it affects others? Same goes with the term healthy, get far enough into a discussion on what it means to be healthy and people will start to disagree. Mental health? Physical? Communal? Spiritual? What’s more is that this term is thrown around in place of simple personality traits or individual quirks. Because someone is more emotional are they now less mature because they have an objectively more difficult time regulating them? Is the person with a dark sense of humour immature because he can’t hold in a laugh when everyone else finds the situation morbid or cruel? I think, to a great extent, it’s a bit of a shield or barrier of a term that absolves ourselves from taking responsibility for our behaviours. At the end of the day we know ourselves best, or at least better than most people. This means we best understand our emotions, how we regulate them, how we control them etc. We have this epistemic bias towards ourselves, since we simply know more about ourselves therefore we will often reason that others have less. Sorry I couldn’t polish off my ideas more I gotta run bye friends"

102K likes, 186 comments - the_philofficer on July 6, 2026: "I AM SO EMOTIONALLY MATURE I have massive problems with this term. Most people would say it means something along the lines of: the ability to understand, process, regulate or communicate emotions in a healthy way. Now the issue is that all of the terms you use to explain it leave so much room for interpretation the definition becomes almost vacuous. To understand an emotion means to know what caused it? To know the impact it has on you physiologically? To understand how it affects your cognition? To know how it affects others? Same goes with the term healthy, get far enough into a discussion on what it means to be healthy and people will start to disagree. Mental health? Physical? Communal? Spiritual? What’s more is that this term is thrown around in place of simple personality traits or individual quirks. Because someone is more emotional are they now less mature because they have an objectively more difficult time regulating them? Is the person with a dark sense of humour immature because he can’t hold in a laugh when everyone else finds the situation morbid or cruel? I think, to a great extent, it’s a bit of a shield or barrier of a term that absolves ourselves from taking responsibility for our behaviours. At the end of the day we know ourselves best, or at least better than most people. This means we best understand our emotions, how we regulate them, how we control them etc. We have this epistemic bias towards ourselves, since we simply know more about ourselves therefore we will often reason that others have less. Sorry I couldn’t polish off my ideas more I gotta run bye friends".

Why major life decisions should be approached with ‘epistemic humility’ | Psyche Videos

At a crossroads in life? No matter how much you deliberate, one unknowable remains: the person you will be on the other side