Conversations in Critical Psychiatry

by Dr Awais Aftab (Editor)

Conversations in Critical Psychiatry brings together an edited selection of interviews published in the Psychiatric Times from 2019 to 2022, updated with new and previously unpublished material. These interviews explore critical and philosophical perspectives in psychiatry by engaging with prominent commentators within and outside the profession who have made meaningful criticisms of the status quo. These conversations advance our understanding of psychopathology and offer a pluralistic vision of psychiatric practice.

The series includes interviews with many leading scholars such as Allen Frances, Anne Harrington, Paul McHugh, Nassir Ghaemi, Dainius Pūras, Joanna Moncrieff, Jonathan Shedler, Sanneke de Haan, Nev Jones and Kenneth Kendler, among others. The discussions cover a wide array of philosophical, clinical, and scientific topics and present a sweeping overview of psychiatrys relationship to critique. A detailed introductory essay 'Psychiatry and the Critical Landscape' offers a synthesis of themes and makes the case for mainstream psychiatry to embrace the critical tradition, while urging critical psychiatry to engage with a philosophically informed view of psychiatric science. Given the accessible and rigorous nature of these conversations, this book will be of interest to academics, clinicians, students, service users, and general readers alike.

Genres: Psychology, Psychiatry

Kindle Edition

Published August 25, 2024

Reviews

[Cal Davie · Rating 5 out of 5]

This was absolutely fantastic, this is a collection of interviews conducted by Aftab with those who have a variety of perspectives on psychiatry. Every interview has a detailed further reading section making this an excellent resource for further study. It's such a complex topic, and having such a diverse range of voices in one volume is very helpful. Awais has truly done something special here.

[Rob · Rating 5 out of 5]

Really terrific series of interviews with some interesting thinkers. I work in emergency medicine which has a fair bit of exposure to mental health presentations, but this book is a really great introduction to a lot of great topics around epistemological issues in psychiatry, the role of society, issues regarding management and has introduced me to a load of new concepts to read up on. Fantastic.

[RH Belmaker · Rating 5 out of 5]

This delightful book of interviews has been partially published before in the Psychiatric Times according to the book’s forward; but it read to me as a fully integrated and complete whole experience in my psychiatric education. I am a veteran psychopharmacologist who has begun asking troubling questions about the assumptions and overuse of psychopharmacology in recent years but Awais Aftab’s book brings my questions into a sharper focus and deeper level than anything else I have encountered. While I had a smattering of philosophy courses many years ago in college, some of the philosophical language was above my head. The book expressly, and rightly, did not try to become a philosophy of psychiatry textbook by explaining any of the difficult philosophical jargon at length. Dr. Awais Aftab phrased questions that were so interesting and well put that it would often raise an interesting contest in my mind to decide after reading a chapter whether Awais Aftab’s question had been the most interesting part or that of the interviewee and question answerer. Aftab’s clout in the field was clear by the fact that his list of chapter authors, former interviewees, include all the top names in critical psychiatry. Awais Aftab’s own philosophy which he expresses several times is to encourage critical psychiatrists to be critical of their own positions to the same degree that they are critical of others. He himself is never polemic, always respectful and amazingly erudite. He is knowledgeable in the philosophy of psychiatry but also in classical philosophy. His questions about philosophical problems regarding DSM are always based on deep knowledge of epistemology and the general psychiatric issue of any classification system. This gives the book a depth far beyond that of the usual psychiatric scrabbles about whether a DSM diagnosis is appropriate or not. Some of Dr. Awais Aftab’s interviewees, such as Dr. Joanna Moncrieff, did not quite live up to his invitation to be self-critical of her own ideas. While Dr. Moncrieff’s chapter befits her role as one of the founders of the field of critical psychiatry and a distinguished empirical scholar of antidepressant side effects and antipsychotic use continuation, her answers are terse and rejecting of any critical questions. I was surprised at the gentleness with which Dr. Aftab was willing to accept her as she is even though she had clearly not responded to his own request for self criticism.

Dr. Aftab includes several leaders and writers of the movement called “lived experience” among other names: These are patients who have suffered from depression or psychosis and who continue to write, study and advocate in the field of mental health. Dr. Aftab has been a major supporter of such leaders and at some point in the book mental health therapists are described quite equally as "those who are experts from reading books” vs "those who are experts from their own lived experience”. Dr. Aftab is gentle, accepting and encouraging to these writers who base their expertise on lived experience. However, he never challenged them in any way to provide any empirical data that their lived experience has allowed them to better help others with mental illness. This is perhaps the one example of an idea that Dr. Aftab did not find a way to critique in this book.

I would recommend this book to every psychiatrist but I think those without any grounding in philosophical language may have a hard time of it. It is the kind of book that makes you so want to meet the author at the social gathering at an international psychiatric conference.

Robert H. Belmaker, MD
Prof. Emeritus of Psychiatry
Ben Gurion University of the Negev
Beersheva, Israel

[Tom Todd · Rating 5 out of 5]

I've been following the author's work online for a few years, now, with an interest as someone who has experiences of psychosis and working in quality systems and regulatory in pharmaceuticals.
This book is excellent. The questions and answers are well-considered, and benefit from the way that Awais conducted them in writing, rather than being sprung on someone.

The book would benefit anyone with an interest in improving present psychiatric practices and is topical, given ongoing work in many countries to do exactly this.

An example question and answer-

Awais Aftab:
On Twitter, you are known as a prominent defender of current psychiatric practice against critics, yet I believe your book reveals a far more critical mind. I suspect if you weren't spending most of your energies defending psychiatry, you might actually have been a critic yourself, of the reductionistic and unreflective tendencies within our profession. What do you think?

Samei Huda:
I will mention a few problems. We have not paid due attention to the adverse effects of psychiatric medications. Even accurate information on frequency of some severe adverse effects is lacking. A patient first described to me antidepressant withdrawal in the mid-90s, yet we still have no accurate estimate of the prevalence of severe withdrawals (or an uncontested definition) for each antidepressant drug so we can inform our patients of the risk...
Another issue is the reduction of the measurement of treatment effectiveness to measurements of symptom reduction or prevention of exacerbations of symptoms. It relies on the assumption that, for all patients, reducing what we describe as symptoms is their priority, and that reducing them will produce other benefits such as improving quality of life and functioning, and preventing other outcomes, such as suicide...

I highly recommend this book.