Back from the Abyss: Psychiatry in Stories

The postpartum period is by far the most psychiatrically vulnerable time in a woman's life. Erin had always some some mildly annoying obsessive-compulsive tendencies, but they were never a major factor in her life, until just after her daughter was born. Almost immediately she was flooded with horrific violent images and urges, these then morphed into a paralyzing dread of viral contamination. This is the first of two parts. This episode is Erin's story of learning to lean directly into her fears, the next episode will be Dr. H and Dr. Amy Indermuehle, an OCD expert and Erin's therapist, deconstructing Erin's treatment and how exposure therapy helped her to reclaim her life. Postpartum OCDhttps://iocdf.org/expert-opinions/postpartum-ocd/https://www.postpartumdepression.org/postpartum-depression/types/ocd/Exposure and response preventionhttps://iocdf.org/about-ocd/ocd-treatment/erp/Dr. Hhttps://www.craigheacockmd.comOn Twitter @bftapod

Listeners ask: "Can I tell my story on Back from the Abyss?""Can you heal trauma that you cannot remember?Dr. H then looks back at 3 years of 800+ ketamine sessions and further explores the question of intramuscular (IM) vs intravenous (IV) treatment, as well as whether reaching full dissociation is necessary for optimal efficacy. Dissociation improves ketamine responsehttps://www.psychiatryadvisor.com/home/depression-advisor/ketamine-induced-dissociative-symptoms-predict-antidepressant-response/Dr. Hhttps://www.craigheacockmd.comOn Twitter @bftapod

If only swimming or meditation were as good as vodka. Unfortunately, the most powerful and rapid-acting coping strategies also tend to be the most damaging and addictive. Annie learned this the hard way. After her father's death when she just 9 years old, she eventually found two of the most alluring and effective coping strategies, and they made day to day life possible, even manageable. They worked fantastically well, until they didn't. Annie found healing through 12 step groups and also through DBT (Dialectical Behavior Therapy) and now works as a clinical psychologist, sharing her hard-earned wisdom and relentless hope with others.Dialectical behavior therapyhttps://www.psychologytoday.com/us/therapy-types/dialectical-behavior-therapyEffectiveness of Alcoholics Anonymous vs other modalitieshttps://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012880.pub2/fullDr. Hhttps://www.craigheacockmd.com

A deeply personal journey unfolds as Mitch shares his experience overcoming severe PTSD through MDMA-assisted therapy. He confronts the pain of childhood trauma with compassion and trust. The transformative power of MDMA reactivates his inner healing intelligence, offering a shield to face his darkest moments. Touch plays a significant role in the therapy, enhancing self-worth and connection. The session reveals the intricate emotions of vulnerability, illustrating the profound impact of sharing personal stories on the healing process.

The root system of a tree is its hidden protection against the harsh realities of wind and drought and disease.  For people, loving and healthy childhood  attachments are our central hidden protection against the inevitable losses and tragedies of life. But what happens when these early attachments aren't safe and secure?Jami's childhood emotional neglect and abuse and profound loneliness left her attachment roots shallow and damaged, yet her inner fire and natural resilience helped her to grow up strong and healthy despite the childhood challenges. When the winds of loss and grief started to blow, she came toppling down, twice. This led to a long list of failed treatments, benzodiazepine dependence and its horrors, and even a brief course of ECT (electroconvulsive therapy) when seemingly all other options had failed. And today, she again stands strong and tall, a testament to her refusal to give up and to relationships that have helped to scaffold her and compensate for those early traumas.Adverse childhood experiences and effects on long-term resilience and risk of chronic illnesshttps://www.acesconnection.com/blog/got-your-ace-resilience-scoresMajor depressive episode vs "nervous breakdown"https://www.psychologytoday.com/us/blog/how-everyone-became-depressed/201309/bring-back-the-nervous-breakdownKetamine vs ECThttps://www.psychiatryadvisor.com/home/topics/mood-disorders/depressive-disorder/short-term-treatments-for-depression-ketamine-vs-ect/Dr. Hhttps://www.craigheacockmd.com

Life is much better on Adderall, until it's not.In this episode, Dr. H and Dan Ronken, a Boulder-based psychotherapist and addiction specialist, explore the double edged sword of stimulants.  Using Dan's ADHD and addiction story as a launching point, they explore questions including:  Do stimulants make us smarter and more productive? What is the saliency circuit and why is it so relevant here? Are some stimulants safer than others? Can they safely be used by people in active addiction or in recovery? What behavioral strategies are helpful with ADD? Can you ever get that same dopamine rush without drugs? They then transition to the question of whether ketamine therapy is safe for people in recovery.Dan Ronkenhttps://www.inclusionrecovery.comDan's Youtube channelhttps://www.youtube.com/user/danronkenDr. Hhttps://www.craigheacockmd.com

In this mini-episode Dr. H explores the critical implications of thinking about Depression as a syndrome rather than as a meaningful clinical diagnosis.  The diagnosis of Depression is but the first tiny step in the journey of exploring biological, psychological, and interpersonal causes and factors which might then point toward effective treatment.Dr. Hhttps://www.craigheacockmd.com

In this second installment of therapists in the abyss,  Dr. H sits down with Jungian analyst and master therapist Dr. Michael Daine to explore how facing death catalyzed an exploration of the unconscious and the eventual rebirth both of his career and sense of purpose in the world.  This then leads to a discussion of whether one can be a capable and resilient therapist without having successfully passed through periods of darkness and despair.Dr. Michael Dainehttp://www.dainepsychservices.comDr. Hhttps://www.craigheacockmd.com

This is the first of an intermittent series of therapists sharing their abyss stories.  Samantha was a newly minted therapist just out of her MSW program, full of hope and excitement for her new career, when she met a client whose horrific trauma story and rapid disappearance from therapy haunted her for years.  Dr. H and Samantha explore how she was able to eventually move from the grief and regret of this vicarious traumatization to a place of acceptance and self-compassion. A heads up— this story contains a description of a sexual assault. Dr. H / Back from the Abysshttps://www.craigheacockmd.com

In this mini-episode Dr. H opens himself up for major audiophile shaming as he (reluctantly) reveals his three desert island albums. With this revelation complete, he then moves on to the challenge at hand-- which three psychiatric medications are at the top of the heap, combining efficacy, safety, and breadth of symptom coverage?A hint-- they all start with the same letter.  And they are all generic.  And psychiatry would be greatly hamstrung without them. Guesses?? Dr. Hhttps://www.craigheacockmd.com