Critical MH/LD Nurse

@samhall404 It’s an interesting one. This was a reply to a minor criticism from me. I actually think he over-apologised for his language here, although I disagree with him on this particular point.

The only “devastating takedown” I’ve seen over the last few weeks was your failed presidential campaign. Even that was less of a takedown and more of a slow, self inflicted collapse.

@FarewellSSRI @ProfRobHoward @ReadReadj @HenryRunamucker @joannamoncrieff Oh, okay. Thanks.

@CriticalMh @ProfRobHoward @ReadReadj @HenryRunamucker @joannamoncrieff Tyler wrote that entire thread ("how I use AI for work and in particular to write twitter posts") in response to a comment that it looked-AI generated. He even screenshot-ed the exact post. I think he's just acknowledging it was written by Claude (though reviewed by him)

This is a well-researched and devastating take down of my UCL colleague and exposes an idiosyncratic and unbalanced approach to the interpretation and communication of Science.

@FarewellSSRI @ProfRobHoward @ReadReadj @HenryRunamucker @joannamoncrieff I see. I’m assuming we don’t know it is, but based on this you suspect it is. Thanks.

@CriticalMh @ProfRobHoward @ReadReadj @HenryRunamucker @joannamoncrieff This is a reason. x.com/tylerblack32/s…

@FarewellSSRI @ProfRobHoward @ReadReadj @HenryRunamucker @joannamoncrieff I’m not sure what reason there is to think that.

@CriticalMh @ProfRobHoward @ReadReadj @HenryRunamucker @joannamoncrieff Plus it was written by Claude anyway.

@PH_OSINT @sulmoney @awaisaftab Interesting thanks. I’m not sure to what extent they work that way across the board, especially with mixed presentations that could potentially map onto multiple psychiatric categories. I think I see it occasionally where the diagnosis is used to justify the treatment preference.

@CriticalMh @sulmoney @awaisaftab I honestly think of them as functional billing codes to a large extent… That opens up options for interventions for categories where we have evidence that it can stabilize/improve quality of life.

“In my practice, I routinely see patients who have been diagnosed with depression and anxiety by one clinician, bipolar disorder by another and post-traumatic stress disorder by a third, at different points in their lives. They arrive confused and frustrated, asking: What disorder do I really have? The honest answer is: all of them and none of them.” Brilliant article by someone I admire

@sulmoney @awaisaftab Thanks. I wasn’t suggesting getting rid of the “bio” so much, it was more the idea of diagnostic categories as practical tools that offer a shared language to describe clusters of behavioural &/or personality phenomena, rather them saying too much about what you have “got”.

I can never speak for others, but I know I was trained in the biopsychosocial model, with equal if not greater weight given to the psycho-social aspects for the majority of my patients. I would estimate that at least a third if not half (maybe even more?) of my overall patient load do have neurodevelopmental disorders, so getting rid of the “bio”, as so many critics online suggest is impossible to do.

@AlinaPrichici33 @awaisaftab @nytimes I think you’ll find that many do, if not necessarily yours, not that I am clear why that is relevant.

@CriticalMh @awaisaftab @nytimes 😂😂😂😂psihiatrii sunt criminalii OMS-ului!nici nu cred in Dumnezeu ei.

When patients ask, “What disorder do I really ‘have’?” the honest answer is usually more interesting and messier than a single label. I wrote for the @nytimes on what I wish people understood about diagnoses and the nature of mental health problems. nytimes.com/2026/05/11/opi…

@texmexjean @sulmoney @awaisaftab Thank you, I really appreciate this. I think it’s always important to remember we’re interacting with other human beings who always have their reasons for thinking & feeling as they do. Enjoy your day.

@CriticalMh @sulmoney @awaisaftab I wanted to say i was scrolling through your page and i love how you bring balance. Critical and inquisitive but open to dialogue. I learned a bunch from your replies.. one of the best recent follows!

@ProfRobHoward @ReadReadj @HenryRunamucker @joannamoncrieff I personally think people should be largely free to use whatever language they want to make their arguments &/or reflect their feelings, but I’m not sure it was a great critique. I think I saw JM misrepresented in first few paragraphs, potentially to justify the “bingo” theme.

@CriticalMh @ReadReadj @HenryRunamucker @joannamoncrieff And I should have said "critique" instead of "takedown". Sorry. But it is right, I think, to use "devastating", because - as Tyler lays out carefully - the pattern of deviation from disinterested and fair treatment of evidence is blatant.

@ReadReadj @HenryRunamucker @ProfRobHoward @joannamoncrieff No problem. I’d agree it’s unhelpful language, that I think helps reduce these important & complex conversations to a political jousting match. I think it probably was intended as a “devastating takedown” rather than “powerful critique” though.

@CriticalMh @HenryRunamucker @ProfRobHoward @joannamoncrieff Fair point. Perhaps I should have said “aggressive” rather than “violent”

@ReadReadj @HenryRunamucker @ProfRobHoward @joannamoncrieff JM has greatly shaped my professional outlook for 20+ years, & I’m often unimpressed by the tone of the criticism levied against her & fellow critics, but if “devastating takedown” is violent language, might we all want to check our timelines to see how we measure up?

@ProfRobHoward What a nasty, unprofessional, but predictable , attack by @ProfRobHoward on colleague @joannamoncrieff using violent language ….’devastating takedown’. How dare she critique a psychiatric drug. So glad his peers rejected his attempt to be president of College of Psychiatrists.

@tillytog01 Yes, sometimes I think I’m watching people sparring with doppelgängers of themselves, albeit on opposite sides of an argument. Of course it’s always much harder to watch a member of your own camp behave in this way, but I guess each to their own. Thanks for your time.

@CriticalMh I agree. I think we also need to remember that we’re all human and can often indulge ideological arguments triggered by emotion and struggle to contain it. This is of course forgivable but less so when they are repeating the same error repeatedly

When someone is intent on hatred we have to ask what’s behind it, what’s driving their behaviour rather than getting tangled up in responding to it. Also it’s important to recognise that sometimes there’s nothing you can do about it

@tillytog01 Thanks. I think temptation sometimes is to indulge, or signal, a sense of ideological disgust or superiority, as it sort of feels like a moral act, but if it feeds a backfire effect in our ‘opponents’, we are potentially putting our emotions &/or kinship-status above our cause.

@CriticalMh I agree emotional states can fuel disagreements exponentially sometimes we all need to take a step back and reflect before any progress can be made. And sometimes no progress will be made at all especially if that step can’t be taken

@tylerblack32 Great thread. Plenty to weigh up. Thanks.

(p.s. except for extreme symptoms, medication has no role in borderline personality disorder, stop prescribing medication for BPD!!! use short-term meds in crisis if you must, but stop the polypharmacy.)

🧵Borderline Personality Disorder (BPD) 🧵 Ask any person who has been even suggested to have BPD; they will uniformly tell you that they have been told to try DBT (Dialectical Behavioural Therapy). Reflexively recommended. "Gold standard." This is not science-supported. /1

@RITB_ Thanks, I’m happy to look as critically at Trauma Informed approaches as I am diagnosis & drug treatment. I’m not that long out of “The Trouble With Trauma” which was a real eye-opener. Thanks for the chat & citation.

@CriticalMh x.com/i/status/20492…

Fancy Marxists talking to papers who have always been fascist, assessing people for ADHD whilst believing in over-diagnosis.

@RITB_ Thanks, I’ll look it up.

@CriticalMh "critical" psychols/psychiatrists/some private psychotherapists want no dx and want 'trauma informed care', but the Durham TIC study suggested 86% of undiagnosed PD

@RITB_ 2/2 imagine them explaining that dx has risks/benefits, but that ultimately the patient has options in how to make sense of their problems, & that they will neither deny or impose a diagnostic framing, & may even explore pharmacological options if that’s what’s being requested.

@RITB_ 1/2 I could imagine a PD/ADHD sceptic/disbeliever potentially telling a patient that their problems/experiences meet the threshold for one/both of these dx, but that this is not the only way to frame/understand their problems & neither does it likely explain them. I could also…