Inside the Neuroscience Community: Peter Sterling Responds to Awais Aftab

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Editor’s note: On July 29, Peter Sterling, a Professor of Neuroscience at the Perelman School of Medicine, published an essay on Mad in America that circulated widely within the neuroscience community. This is his response to a critique of his essay by Awais Aftab, which was published on Substack.

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I welcome the opportunity to respond to Dr. Aftab’s critique of my essay, “Causality in Mental Disturbance: A Review of the Neuroscience.”

First, he objects correctly that my essay is not, as advertised, “an original research article” or “scientific paper.” Although the editor of Mad in America, Peter Simons, did run that line by me, I was distracted, and rather than pausing to consider, I simply assented. The fault is entirely mine.

Scientists are trained, by the way, to listen to our critics, try to grasp where we are wrong, and rectify. Accordingly, I have asked the editor to replace that introduction with the following:

“Here is one neuroscientist’s overview of what we don’t know about the brain regarding mental disturbance and what we should not be doing to the brain physically and chemically as ‘therapy’. Sterling’s perspective ‘follows the money’ to Big Pharma and Big Devices—corporations that dominate psychiatry’s current model of mental disturbance to sell their stuff. He continues down the money trail to Big Academy and Big Publishing who share the take, and he calls out some names.”

Dr. Aftab is also correct that my essay would never have been published in a conventional journal—because it is far too critical of the current story about mental “illness.” Only Robert Whitaker, the scientific journalist and publisher of Mad in America, would have the courage. Before submitting the article, as customary, I sought comments from nearly a dozen senior neuroscientists and neurologists. Not one challenged any of my neuroscientific assertions; not one asked me to tone it down. The published piece has been well-received by various senior neuroscientists and none, so far, have disputed its core points.

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Dr. Aftab opens with a nod to taking me seriously because I am a “distinguished neuroscientist and Professor at UPenn School of Medicine.” But his next sentence casts doubt. So here I explain why readers should take me seriously. Not because I’m “distinguished,” but because I am well-informed.

Over the span of my career, now 60 years, I investigated the neural structure and function of the mammalian brain from the scale of synaptic vesicle release (nanometers) to the scale of local circuits (micrometers to millimeters), ultimately up to the scale of the whole brain, tracing the cortico-spinal connections (meter). Upon closing my laboratory, I integrated my knowledge across these levels to set out some broad conclusions in a book, written with Prof Simon Laughlin, Principles of Neural Design (2015). From there I stepped upward with a book on human evolution, What is Health: Allostasis and the Principles of Human Design (2020). This book integrates the science underlying human physiology and behavior as it emerged across 4 billion years, emphasizing especially the last 200,000 years, since we emerged as a species.

Although my laboratory studies were hyper-reductionistic, I claim creds to write broadly on human behavior and its disturbances. First, I have published articles across nearly five decades on society, stress, and the brain’s predictive control of physiology. Most of these articles were in conventional scientific journals, including eLife, Physiology and Behavior, Trends in Neurosciences, and JAMA Psychiatry. Second, I have worked outside the academy as a lifelong activist for civil rights and for building cooperative community life. Third, I have investigated the lives of indigenous peoples, visiting across four decades various indigenous communities in Central America. Fourth, for the past 20 years I have lived and farmed in the highlands of western Panama where my wife and I cooperate intimately with our neighbors—families of indigenous agricultural laborers and campesinos. Our small community governs itself without police, drug deaths, suicides, or shootings. No one in this community is unhoused.

Contrary to Dr. Aftab’s innuendo that I seek “deference,” I seek, as a committed scientist, challenges and alternative views based on serious study and thought. As a committed scientist, I reject “fake news” promoted by commercial interests. Dr. Aftab scorns my comments on ECT, saying “he [Sterling] is not a clinician.” But what does a young “clinician” in psychiatry really know these days? Mostly what they learned from the interns and residents just ahead of them. And what do they know? Mostly the story that mental disturbances are biological “disorders” that can be treated by interventions at the level of synapses and circuits. This story has been manufactured since the lobotomy days by neurosurgeons and psychiatrists (less so by neurologists) and promoted by Big Pharma and Big Devices through their “detail men.”

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Dr. Aftab responds to my essay with a “meta-essay,” chiding me for incorrectly analyzing Dr. Siddiqi’s essay and for straying beyond its boundaries. Dr. Aftab objects to my “broad-sweeping conclusions,” my lack of “humility,” my “grievances against psychiatry,” and my “tirade against psychiatric neuroscience.”

To be clear: I hold no general grievance against psychiatry. To the contrary, I have sought psychotherapy at various crisis points in my life and benefited enormously from two wise and empathic psychiatrists. My so-called lack of humility simply reflects clarity and confidence. Confidence emerging appropriately from my broad knowledge and my rich experience across two cultures with families, neighbors, close colleagues (several intermittently psychotic) and students (ditto)—plus my own children and grandchildren. Should an old man apologize for writing based on his integrated experience? I offer this now as a sort of public gift. I expressed no “tirade” against “psychiatric neuroscience”—although I do regard that expression as an oxymoron.

What Dr. Aftab does not do is address any of my substantive conclusions—here summarized with links to supporting publications:

(1) Current medicalization of all social and psychological suffering is unjustified by the currently known neurobiology.

Psychiatry’s diagnostic manual lists hundreds of behaviors, deviating from the mean by 1-2 standard deviations. It calls them “disorders” and designates them with numbers and names: “schizophrenia,” “major depression,” “bipolar disorder,” “obsessive-compulsive disorder,” and “attention-deficit/hyperactive disorder.” These are said to be “just like” genuine brain disorders, such as Parkinson’s. But recent large-scale imaging studies fail to identify brain correlates with any of these behaviors. Earlier such claims, often published in high profile journals, are now proven to be bogus (Sterling 2022, 2023).

Nor do recent genetic studies support the story of multiple, distinct brain disorders. Rather, they find genes associated with mental disturbance to number in the 100s to 1000s. Moreover, genes associated with one “disorder” overlap strongly with those associated with the other disorders, suggesting that they are not distinct “diseases” but rather different manifestations of a shared mental/behavioral trait. This hypothesis receives support from a four-decade longitudinal study showing that most individuals who express one type of disturbance eventually express them all, either successively or simultaneously (Caspi et al 2020). Finally, here is Daniel Geschwind (UCLA Professor of Human Genetics, Neurology and Psychiatry) summarizing the neuroscience of mental disturbance in his 2017 talk at the Allen Institute:

“Psychiatric disorders are syndromes… What we call psychiatric diseases are just levels of impairment… The threshold is not scientific but a clinical/practical threshold for when individuals are unable to function in the world. These syndromic diagnoses are not etiologically defined… just one end of a continuum of normal variability… For most disorders it’s the common variants that move an individual toward that threshold, and sometimes a rare variant can push the person over.” (My emphasis)

Geschwind, a world-class researcher (and clinician), is a core figure in the search to identify the normal function of the trait that can involve mental disturbance. Here he denies the stories concocted around the “syndromic diagnoses”: he denies that they are “diseases.” Notice that the genetic and the longitudinal studies cited here combine to support the view of Dr. Thomas Szasz—that mental “illness” is a myth. Szasz, long scorned, now proves to have been prescient.

(2) Absent any identified neural pathology there is zero rationale for interfering with brain circuitry either mechanically or chemically. This is simple logic: if you haven’t identified anything as “broken,” there can no rationale for “fixing.” Dopamine and serotonin are not “just like insulin”—as the Big Pharma story goes—so there is zero scientifically based rationale for administering any of the brain drugs marketed over 70 years, nor for psychosurgery, ECT, TMS, or DBS.

Dr. Aftab apparently accepts at face value the so-called “randomized clinical trials” as evidence for efficacy and safety. Such trials serve to bamboozle the FDA. But of course, they are designed by Big Pharma and Big Devices to slip across the “p” line in small, short-term trials with rudimentary evaluations of mental functioning—such as “rating scales” which themselves wither under scientific scrutiny (Fried et al 2022). As richly documented in Whitaker’s and my publications, such weak studies are not confirmed by subsequent larger and longer evaluations (Whitaker 2023; Sterling 2020, 2022, 2023). Consequently, all the jiggering with human brains from childhood through old age are simply bizarre manipulations promoted for commercial reasons and for reasons of social control. Two generations of physicians trained on these stories—myths—simply don’t know any better.

Consider, for example, a trait that affects activity level and attention to external authority. Most children—those near the mean of a normal distribution—can sit quietly for 45 minutes and attend to a “teacher.” But the idea of distribution implies other children off the mean, including some (~10%) off by 1-2 standard deviations. There is no neuroscience to suggest that children within two SD of the mean have abnormal brains. There is simply a story—children with a certain score on a checklist have a brain disorder—concocted by Big Pharma and its associated academics, to legally sell amphetamines as “medicine.” Long-term follow-ups regarding success and stability in career, family, mood, and so on show no advantage for those treated with stimulants during childhood. On average, however, they are several inches shorter (Hecht et al 2016).

My essay terms all brain manipulations to “treat” mental disturbance (surgery, drugs, electrical and magnetic stimulation) as Ponzi schemes. They are not like Ponzis—they are actual Ponzis, as defined by Oxford: a form of fraud in which belief in the success of a nonexistent enterprise is fostered by the payment of quick returns to the first investors from money invested by later investors. Ex: “a classic Ponzi scheme built on treachery and lies.”

Dr. Aftab objects, saying “These are quite strong claims.” Yes, for sure! I have studied such claims for half a century—that mental disturbance arises from pathology in neural circuits and warrants some new physical intervention. These have always proved to be “nonexistent enterprises” that earned quick returns. Since there was never a rationale, of course they couldn’t help over the long term. They did, however, cause all sorts of chronic brain damage. By then the enterprise had always moved on to the next story. Here I am playing the old man’s role: to recognize the same old Ponzis and call them out. New generations of neuroscientists and psychiatrists need to abandon these bogus stories and move forward to invest in honest projects.

Some colleagues respond: your points are true, they say, but someday we might really understand these circuits, and that is a positive goal. Of course! What could be deeper than to discover the differences between sane thoughts and disturbed thoughts, between a steady mood and its extreme highs and lows. But right now we do not understand, and so there is no rationale for any physical/chemical tinkering. None of it works over time, and it generally retards recovery (Whitaker, 2023). Meanwhile, it enriches Big Pharma and Big Devices, Big Publishing, and select corners of the Academy—while damaging the brain.

References

Caspi A, Houts RM, Ambler A, et al. (2020) Longitudinal Assessment of Mental Health Disorders and Comorbidities Across 4 Decades Among Participants in the Dunedin Birth Cohort Study. JAMA Network Open. 3:e203221.

Fried EI, Flake JK, and Robinaugh DJ. (2022) Revisiting the theoretical and methodological foundations of depression measurement. Nature Reviews Psychology, 1: 358–368.

Sterling P (2020) What is Health? Allostasis and the Evolution of Human Design. MIT Press.

Sterling P (2022) A Neuroscientist Evaluates the Standard Biological Model of Depression madinamerica.com/2022/10/neuroscientist-evaluates-depression/

Sterling P (2023) Causality in mental disturbance. https://www.madinamerica.com/2023/07/causality-mental-disturbance/

Sterling P, Platt ML.( 2022) Why Deaths of Despair Are Increasing in the US and Not Other Industrial NationsInsights From Neuroscience and Anthropology. JAMA Psychiatry. 2022 Apr 1;79(4):368-374.

Hechtman L et al. (2016) Functional Adult Outcomes 16 Years After Childhood Diagnosis of Attention-Deficit/ Hyperactivity Disorder: MTA Results. J Am Acad Child Adolesc Psychiatry 2016;55(11):945–952.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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16 COMMENTS

  1. THANK-YOU, Peter Sterling! BRAVO!….dude, you hit that sucker square in the stitches, sailed ‘er right over the outfield fence, and clean out da ballpark!…. Putative “Dr.” Awais Aftab is still shagging grounders in Little League with the other schoolkids. Taking my own long-suffering direct lived experience as a successfully “escaped mental patient”, may I re-paraphrase the article above thus:

    “Psychiatry is a pseudoscience, a drug racket, and a mechanism of social control. It’s 21st century Phrenology, with potent neuro-toxins. Psychiatry has done, and continues to do, FAR MORE HARM than good. The DSM is best seen as a catalog of billing codes to be submitted for payement to the insurance industry, and tax-payer-funded governments at local City, County, State, & Federal levels. EVERYTHING in the DSM was either invented or created in the last 100 – 200 years; NOTHING in the DSM was discovered as pre-existing it’s creation or invention. So-called “mental illnesses” are exactly as “real” as presents from Santa Claus, but NOT MORE REAL. Real people have real problems of living, but imaginary “mental illnesses” should not be part of that.”

    By 10th grade, I was a cannabis-smoking blackout drunk, when my desperate parents took me to a local psychiatrist. I don’t blame them now, – I’ve forgiven them. They were as brainwashed by the Psych Guild & PhRMA as I was. The quack shrink gave me a bogus “diagnosis”, and an Rx for powerful neuro-toxins. I was off to the races. The next 20+ years of my life were a living hell, thanks to the pseudoscience drug racket of psychiatry. I read Dr. Peter Breggin’s “Toxic Psychiatry”, and Dr. Thomas Szasz’s “Myth of Mental Illness”, along with other such works of scientific art, by the early 1990’s. I have been 100% sober from alcohol since 1991, largely thanks to A.A., the “Big Book”, and the “12 Steps”. I was last hospitalized “psychiatrically” in 1994, when the quack shrinks at the local “community mental health center” had me on “Trazodone”, which they claimed to be an “anti-anxiety, with a sedative side-effect”. I was at that time still only 1/2 awake & aware. I went toxic on the Trazodone, because they FAILED to do any blood test to prevent inadvertant overdose due to a slowed drug metabolism. Alcoholism & liver damage & disease are strong indicators of the need for more frequent & vigilant monitoring of drug patients/victims. By 1996, I became psych-drug-free, and have not seen a psychiatrist since. Given that I have been back in my small hometown since 1987, I have witnessed first-hand the CARNAGE WROUGHT by the pseudoscience lies, and neuro-toxins passed out like candy by irresponsible prescribers. The so-called “community mental health center” paradigm has proven to be either an abject failure, or a glowing success, depending on how depraved and ignorant you are. Psychiatry has done, and continues to do, FAR MORE HARM than good.

    I doubt that “Dr.” Awais Aftab is man or scientist enough to respond to me here, and I don’t expect that Peter Sterling will need to reply, rebut, or comment.

    “ECT” = Electro-Cution Torture….prove me wrong?….
    (c)2023, Tom Clancey, jr./Bill Bradford Hutchinson
    2023 Keene, N.H. Mayoral candidate…..(& Keene NATIVE!, lol….)….

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    • I had written a funny to me post ghostwriting an imaginary Mr. Aftab answering to Bradford, who now I realized I confused with Birdsong!, asking him to joint Mr Aftab after admitting thoughts used by psych professionals that when expresed by other people might render them labeled with psychosis.

      The inspiration for that post came to me from my lived experience with people who behave as if telepathy, human dream visitation and mindreading were a real thing, outside the clinical office. Sometimes in peculiar ways involving video and still photography.

      I always respected and still do people who have and express those beliefs. I had even been roughly handled on said beliefs with nothing than sympathy and understanding.

      But not for psych professionals, they to my mind behave as I tried to mentioned and yet persecute others, that to my mind, belief and layperson behavior analysis are for this purpose the same. Admitting we all are different.

      Aware that professional mimicry that serves the higher purpose of labeling someone who resists admitting having such beliefs will be the psych professionals justification. Make them comfortable faking you believe sort of thing.

      Unshakably aware that it’s a mirror image of the use of mimicry, and the specific beliefs I tried to “explain”. Poorly.

      Like faking a believer when the believer is faking leading to maybe no one is faking, they both share the belief and the labeler is, well, a psych pro.

      My motivation was to literary exemplify that when fake, fraud and ill-will are involved in the way psychiatry is deeply impregnated in practice distinguishing who is who, is irrelevant. It can only lead to comedy or tragedy, in my opinion.

      No productive dialog, just flyinging stuff like, well, inflamatory speech to say the least. See below if interested…

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  2. I have suffered from bad trauma, a low mood and obsessive compulsive symptoms. I have also suffered from antidepressant induced mania as a result of SSRIs prescribed for the same. For a short while on a few occassions, they made me psychotic, but I came out of it (I’ve read that apparently psychosis can cause changes which can be picked up on MRIs too).

    I know the undermentioned isn’t an fMRI (which would light up regions where blood flow is higher and hence shed light on function rather than merely structure), but rather an MRI which shows the structure of a brain (psychiatric supporters talk about MRIs too though). I have heard from psychiatrists and patients alike that “MRIs show A and B abnormailty in people with X and Y disorder”. I got tired of listening to his crap and decided to get an MRI of my brain myself.

    Here is an MRI of my brain (the link will only be valid for 2 days).

    The radiologist’s observations were:

    i.) Brain stem and cerebellum are normal. ii.) Cerebrum is normal. No focal lesions noted. iii.) Ventricular system is normal. iv.) Basal cisterns, sylvian fissures and cerebral sulci are normal. v.) Visualised cranial nerves appear normal. vi.) Internal auditory canals and their contents are normal. vii.) Visualised dural venous sinuses and deep cerebral veins are normal. viii.) Sella and pituitary gland appear normal. No obvious lesions noted. ix.) Orbits and their contents are normal.

    The neurologist could make out no structural abnormalities either.

    I wish I had this in the late 2000s to shut the mouths of mental health workers and even patient supporters online bringing up this crap. But I was a young kid and knew barely any of this then. I got this MRI in November, 2022.

    I would recommend anyone who is told this crap in the context of psychiatry to do as much imaging on their brains as possible to protect themselves from being told this rubbish because it’s a way in which they force psychiatry onto you.

    It is true people suffer from problems of all kinds: depression, anxiety, panic attacks and what have you. If you think taking pills makes you better, hell take them. But don’t be sold this crap for the wrong reasons.

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  3. Just to add, psychiatric treatments by way of them labelling me as “bipolar” as a 16 year old in the 2000s (due to mania caused by antidepressants, something which never happened prior to the drugs) brought nothing except incessant gaslighting into my life. The person primarily responsible for the gaslighting and the utter mental torture I faced (a family member who is also a doctor and the person I was born to and who is just as horrible as ever) completely escaped. He was never taken in for psychiatric evaluation. It is only I who ended up in this crap and got reabused and gaslighted even more for apparently being a “genetically defective mad person”. The gaslighting I endured from him and his horrible behaviour is still traumatic for me and it still affects my studies. All of this has damaged my life, career, social, academic and marital opportunities.

    Granted, there were helpful aspects of psychiatry that have been beneficial. But for one good thing there are at least twice as many bad things that come out of it. This has not been my experience with cardiologists, dentists, surgeons, doctors of internal/general medicine, dermatologists or anywhere where medicine of the body and not some haphazard half-baked field dealing with character, conduct, personality, sanity, mood, behaviour etc. is involved.

    Anyway, I fought a lot against such labelling and got only disease-mongering and character assassination in return from psychiatrists.

    This is what psychiatry often does. They claim to heal you by doing exactly that which damages you in the long run and when the fallout takes place, they’ve totally escaped. Transfers, retirement and death become convenient escapes while the new batch that comes up has learnt the same dirtbox methods of “help” and how to BS clients from the previous batch. You’re drowned out in the new hoard of people suffering from mental health/social issues after that and only have your own life to live with the damage, even if inadvertent, done.

    Patients are sometimes even worse than the psychiatry “doctors”. A person with a relatively milder, less stigmatising “diagnosis” will rant and rave about how great his psychiatrist is and invalidate people who speak about how damaging it is for others in a situation different than theirs.

    Many smug a-holes in psychiatry write “you don’t like psychiatrists, don’t go to psychiatrists!”. When you’re a teenager and you are helpless and out of options, this is where people direct you. Then you get stuck due to a myriad of factors. So, I say in return “don’t want to be called out on damaging treatments, don’t take psychiatry!”. Become a dentist or a cardiologist instead. If you’re doing nursing, stick to being a non-psychiatry RN or do CRNA or something like that. You want to help people, do it like a normal person on your own time. If not, don’t lie to the suffering people who come to you. Stop being a bunch of weasels and try to con people into accepting that being labelled as bipolars, schizos, borderlines etc. is for their own good and then rant about “mental patients blaming psychiatrists without doing something to turn their life around”. Your barbaric “help” makes turning our lives around next to impossible and fairly often affects us for life.

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  4. The reply by Mr. Aftab seems a precious exemplary case of psychiatry’s blaming others of what practitioners of it do. There are so many statements that seem fallacious to me, that oddly are apt when applied to Mr. Aftab’s tirade. Like spitting upwards…

    If not for involving terminology that would numb the logical brain, it probably should be used as an example of a very poorly formulated set of statements that are intended to provide a response by an expert full of fallacious appearing statements on a first look. No going into the specifics is needed to be apparent.

    I am no linguist, no lawyer, of course no psychiatrist, and no neuroscientist. Sometimes apt critiques and insights come from people outside the field of expertise. I am not claiming that for me either.

    To me, Mr. Aftab’s piece even uses some inflamatory language: A. tending to excite anger, disorder, or tumult. B. tending to inflame or excite the senses. C. [U]sed with the intent to stir up emotions, elicit anger, or invoke a physical reaction. Easy for me to see when I notice the use of WE* with an imperative, followed or preceded by expressions of not disagreeement, but intolerance/spite and at least dismissiveness.

    Mr. Aftab’s piece also lacks what Mr. Sterling indicates without being explicit, despite Mr. Aftab seems to invoque his quality of expert of psychiatry: To me Mr. Aftab at least in this piece shows no useful knowledge of the history of his profession and/or field of expertise. He might know about it, but he does not use it.

    And that is patently obvious to demerit of his “response” because he quotes new studies to support his, I asume expert opinions despite his lack of use of the history of his profession, without taking into account the fact, to me beyond doubt, that psychiatry and it’s practitioners are notorious for claiming successes that end up feebling. Clarifying: Mr. Aftab’s opinions might not derive from his expertise, hence my skepticism.

    He repeats that same psychiatric rhetoric several times. More of the same, whatever positive evidence he provides for his piece, in a few years, aprioristically and by it’s irrationality, let alone historically, most likely will be proven not only false, but damaging.

    Without going into details, not needed, because basic biomedical research is irreproducible 50% of the time, and psychology is no better. Beyond the history of psychiatry, which at least to me seems way worse.

    Going into details of psychiatry’s hypothesis to refute or reply Mr. Aftab will probably prove useless. He probably can quote studies, anecdotes and personal experience/opinion to no avail, just like psychiatry and it’s practitioners have done in the past, and is so well documented.

    Mr. Aftab’s piece seems directed to psychiatry’s flock, it appears to me an attempt at roasting, even lynching Mr. Sterling, at least in Mr. Aftab’s mind.

    Notes.
    Uses inflamatory words/phrasing like: irksome, rambling, meandering, “opinionated blogpost”, arrogance, anti-medication bias, ironic statements(“Oh, you don’t need daily pills, you just need a daily handshake!”, even if requoting). “Forgive me for not taking…”, Szaszian claim, “he is not a clinician”, “Sterling misrepresents”, grotesque comparison, veiled accusations of ignorance (“I don’t know if Sterling realizes this…”)

    Divination/mind reading(apparently): “Sterling so upset…”. This one to me sounds like a typical bully mockery.

    *
    “is not something we should have much patience for…”, “Should we let people languish…”, ” we should all channel the critical spirit” (inteded apparently as irony), “…not the case that we are completely ignorant…” (seems to suggest by implication Sterling is, even if it seems formulated as a defense, since it’s not an argument, it’s a statement), “We understand many crucial piece” and “we know that there is a link” (points to Sterling’s ignorance without providing proof to the claims of Mr Aftab).

    The last 3 “we”‘s, when paired with the rest of the text, in my opinion, seem to invite in a very discrete way the psychiatric or pro-psychiatric community to something, like an unstated “we are being aggravated” and “we know so much”. “Ignorance is a attacking us”, and so forth. Peculiarly supported to my mind, when probably for outsiders the impression of this “discussion” between Mr. A. and Mr S. might have been at least in part about lack of evidence…

    As a final thought: If I were Mr. Aftab’s patient and I spoke to him like Mr. Sterling, would he treat me like he did his piece of paper/screen?.

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  5. The problem isn’t just with psychiatry and the allure of financial profit pulling people’s strings like marionettes, but humanity’s predatory and underhanded nature as a whole.

    When you are in a privileged position based on biological makeup, socioeconomic status, or degree of education you use that to your advantage to abuse, take advantage, and screw over those who are desperate and less fortunate.

    It’s precisely why I don’t trust people who present themselves as experts in their fields anymore since whatever altruism and good intentions they may have had eventually mutate into hubris and a need to push their respectability politics (accusing people of being shrewd, hostile, or aggressive in their criticisms and using that to undermine their arguments), and psychiatrists have this down packed.

    Psychiatrists are relentless in their pursuit to impose compliance and conformity onto their patients with chemical pacifiers and stigmatizing diagnoses instead of addressing the very real psychological problems disabling their patients’ ability to function in their personal, social, and professional lives.

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  6. Awais Aftab has form. He will try and appear reasonable when engaging critics of pscychiatry but I have never seen Awais Aftab refute his critic of pscychiatry with facts.

    He gets annoyed when people use science to criticise his arguments, it punctures his pride.

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  7. Dr. Simon,
    A powerful and direct response to Aftab.

    Allow me to add my modest challenge to Dr. Aftab from the perspective of a real-world ‘client’-targeted and exploited, with documented ‘treatment’ damages, AND achieving a capitulation of the ‘life-time, evidence-based’ labeling/diagnoses Aftab defends.

    You….

    “Dr. Aftab objects to my “broad- sweeping conclusions,” my lack of “humility,” my “grievances against psychiatry,” and my “tirade against psychiatric neuroscience.”

    Dr. Aftab would do well to give me a call/mail (really), as I can counter each “objection” with hard-copy evidence…generated by his own industry….checking every box.

    It was the rarest of (silent) surrenders by his industry.

    There is nothing “broad”, arrogant, grievance-like, or resembling a “tirade” in reporting my experience with Dr. Aftab’s industry.

    It is based on His Industry’s Own Records…
    In a box in my closet, supplied to me by the ‘exit’ (oh, yes) psychiatrist, the CMO/VP of Arizona’s Partner’s in Recovery RBHA system in 2016.

    I can supply Aftab with 9 years of clinical notes and history, primarily generated by his industry, that spans the blue-chip private practice to ‘community’ (Medicaid) clinic-Florida to Arizona, homeowner to homeless & bankrupted from side-effects, quantifiable damage reports from hospital records/interventions (medical floor/ED-NOT psych), and most significantly….

    The capitulation by his industry of their life-time SMI diagnosis, as a bargaining chip to avoid minor lawsuit regarding an ‘incidental anaphylaxis event they caused during prescribing…over my spoken objections. BTW, legal action was never discussed…

    I was the documented, adult-in-the-room THAT day….and (yet according to them) hopelessly, Severely Mentally III.

    If Aftab’s industry BELIEVES their own “evidence-based science”…..why would they risk endangering ME (& the community) further by withdrawing me off all psychotropics…AND sending me on my way with a written NOS Anxiety ‘diagnosis’ AND written rescension of their SMI certification?….all over a prescribing ‘error’?

    One conclusion could be made that anaphylaxis cures bipolar disease…a scientific breakthrough NO ONE at the APA responded to when I emailed them with this ‘evidence-based’ nugget of truth.

    I have THAT exchange also. They stayed true-to-form in their response, suggesting that I call 911 if experiencing a crisis…!?

    The ONLY conclusion that can be drawn from those actions (by the exit doctor, an esteemed, published Fellow of the APA)) is…. Cost & Liability Containment Uber Alles…the motto inscribed over the (interior) doors at APA headquarters.

    Dr. Aftab…any ‘humble’ comments to the targeted? Or just to the ‘science community’?

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  8. I thank you for this article. It validates what I have observed and often fought against, while watching my mother abused by those in the field of psychiatry for over 4 decades. It was horrendous for her and for our family to endure with her.

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