1/ "Whereas symptomatology is strictly illness oriented, psychopathology is also person oriented, since it attempts to describe the patient’s experience and her relationship to herself & to the world."

G. Stanghellini & Matthew Broome (@matthewrbroome)

cambridge.org/core/journals/…
2/ "The patient is an active partner in the diagnostic process, capable of interpreting her own complaints. Symptoms are conceptualised as the outcome of a mediation between a vulnerable self and the sick person trying to cope with and make sense of her complaints."
3/ "The existing classifications of mental illnesses are merely provisional diagnostic conventions... if psychopathology is conflated with nosography, only those symptoms that are supposed to have diagnostic value will be investigated,...
4/ ... in a sort of nosography-focused twilight state, where we wear clinical blinkers structured by contemporary classification systems.... In psychopathology, what matters most is that the ‘chaos of phenomena’ should stand out in an evident way and in multiple connections."
5/ "[Phenomenological psychopathology] assumes that the primary object of psychiatry is the patient’s subjectivity, thus putting all its efforts into focusing on the patient’s state of mind as it is experienced and narrated by them." Stanghellini & Broome (@matthewrbroome)

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More from @awaisaftab

5 Jan
1. Great paper by @HengartnerMP & @Altostrata, based on quantitative analysis of a case series. Given the paucity of previously published literature on this, this is an important contribution. Some thoughts and questions that come to my mind:

journals.sagepub.com/doi/full/10.11…
2. Chouinard & Chouinard criteria also specify criteria related to reversibility of symptoms & partial/total response to reintroduction of discontinued drug. It is unclear if these criteria were also applied as selection criteria.
3. To the best of our knowledge, unless future studies show otherwise, PWS appears to be a rare occurrence, but even rare occurrences can become common if the number of people being treated is large enough, & this is no reason to disqualify the suffering of those afflicted.
Read 8 tweets
8 Dec 20
Some weeks back I had asked for articles on how to best understand & approach "treatment resistance" in psychiatry. I was preparing for a talk & wanted to see what ppl thought. It was interesting to see the mere mention of TR provoke some emotionally-charged responses! /1
Anyway, here are 3 articles I really enjoyed and found very useful on the topic of "treatment resistance" in psychiatry (mostly focused on depression) which offer a non-mainstream, critical view of the concept. /2
i) Treatment-resistant depression: problematic illness or a problem in our approach?
Malhi, et al. British Journal of Psychiatry. /3

cambridge.org/core/journals/…
Read 6 tweets
30 Oct 20
Interview with Peter Zachar from my @PsychTimes series has been reprinted in @IntRevPsych in a slightly abbreviated form (will appear in print as part of an issue on the theme of Conceptual Psychiatry). /1

tandfonline.com/doi/full/10.10…
"The imperfect community is a non-essentialist idea, namely, that the various members of the class of psychiatric disorders have many things in common, but there is no one thing (an essence) that they all have in common that distinguishes them as a group from non-disorders." /2
"The resulting domain is, however, not random or arbitrary – new constructs have been introduced for reasons that reflect our scientific goals and pragmatic interests. Zachar is sceptical about the possibility of a single correct and privileged psychiatric classification..." /3
Read 6 tweets
30 Oct 20
There is much about antidepressant withdrawal that requires on-going scientific investigation (it has been a neglected area of research at all), but there is little doubt in my mind that it is a serious problem that requires to be acknowledged & addressed without evasion. /1
As an early-career psychiatrist in the US, what is striking to me is the disconnect between what I learned abt AD withdrawal during my training & what I learned abt AD withdrawal from the literature being shared & discussed on social media, often by patients & critics. /2
I am reminded of the 2018 New York Times story on AD withdrawal which prompted replies from several psychiatrists as letters to the editor. Some of these replies have not aged well, to say the least. /3

nytimes.com/2018/04/09/opi…
Read 8 tweets
9 Oct 20
This intro to Derrida is such a gem! I feel obliged to post several quotes in this thread!

Derrida “was in this respect more truly a philosopher than those who question everything except the peculiarities of their own methods of questioning.”
“Louis Althusser said that he could not grade his dissertation because “it’s too difficult, too obscure.” Michel Foucault could do little better, remarking: “Well, it’s either an F or an A+.””
“For Derrida, it is not that nature has no joints, or that the world can simply be carved however we please. Rather, there is always more than one way to carve, and every slice divorces us from possible alternative ways of seeing and understanding.”
Read 6 tweets
7 Oct 20
*A thread*

Imagine if u believed (not as a skeptical hypothesis, but genuinely believed) that all psychiatric medications are ineffective & harmful for vast majority of ppl who take them, imagine the epistemic demands this would place on the rest of ur worldview. /1
You would have to explain how an entire medical & scientific profession (& society in general) has arrived at the opposite conclusion over the last 60-70 years. You would have to discredit the entire body of research as flawed, unreliable, conflicted. /2
You would have to question the intelligence, knowledge, or motives of generations of clinicians & researchers; you would have to see signs of corruption & cover-up at every step of the way; you would have to see psychiatric textbooks & education as instances of propaganda. /3
Read 13 tweets

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