Back from the Abyss: Psychiatry in Stories

Anxiety and pain are the primary drivers of medical visits, as well as two of the more complicated symptoms to break down in a meaningful way. In this mini-episode, Dr. H presents the metaphor of "below the neck" vs "above the neck" anxiety to help us think about anxiety in a way that might better guide diagnosis and treatment. "Above the neck" anxiety emanates from the ruminating/imagining/obsessing/spin-cycle brain, while "below the neck" anxiety is the body's fight/flight response, with adrenaline coursing through the body to send the blaring smoke alarm signal of impending danger...even where there is no apparent immediate threat. It matters greatly whether anxiety initially sparks from above or below, and the failure to pinpoint the source can lead to treatment failure and prolonged suffering.  Obsessional/ruminative anxiety responds best to mindfulness meditation, cognitive therapy, and SSRIs; somatic/adrenaline anxiety requires interventions such as biofeedback, (intensive) aerobic exercise, meditation, beta blockers, and the various somatic trauma therapies (EMDR, somatic experiencing, Hakomi). Benzodiazepines address both types, but at significant potential cost. Dr. Hhttps://www.craigheacockmd.comSupport the show

In psychotherapy, it’s the relationship itself that heals.  In this episode of BFTA, Dr. H and his patient Jasmine explore their always complicated, often humorous, and at times very painful journey through the minefield of borderline personality disorder. A heads up on this episode— Jasmine and Dr. H discuss self-harm/cutting and suicidality in a very frank and perhaps unsettling manner. BPD overviewhttps://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder/OverviewLifetime course of BPDhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500179/Dr. Hhttps://www.craigheacockmd.comSupport the show

As her father descended into years of meth-induced rages and psychosis,  Kate and her family repeatedly tried to flee...but there was no place to hide. And when at last, after finishing college and starting a new life with her husband, she thought she had escaped the demons of her past, a phone call lit her world on fire. Kate eventually found a way to heal through a six year treatment journey with the help of a deeply caring and skilled therapist and the tool of EMDR.This episode is the second in a two part exploration of healing through EMDR.LinksComplex PTSD and EMDRhttps://www.goodtherapy.org/blog/complex-trauma-emdr-can-help-but-its-no-quick-fix-0425165http://www.coping.us/images/Korn_2009_EMDR_with_PTSD.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5904704/Dr. Hhttps://www.craigheacockmd.comSupport the show

Sometimes trauma settles deeply in the mind and body and wreaks a kind of clandestine subterranean warfare, turning the body against itself and manifesting strange, frightening, disabling, and even life-threatening symptoms. Sophie's trauma simmered for 16 years, making her life difficult but still mostly manageable. Suddenly, however, she was waylaid as her trauma metastasized into something infinitely more dangerous.  A long torturous course through emergency rooms and various specialists eventually ended up on a therapist's couch, holding an oscillating paddle in each hand, walking directly into the mindscape of her mother's death.LinksEMDR (Eye movement desensitization and reprocessing)https://www.emdr.com/what-is-emdr/https://www.scientificamerican.com/article/emdr-taking-a-closer-look/Video explaining fight/flight (sympathetic nervous system) vs freeze (parasympathetic nervous system) and their roles in PTSDhttps://www.youtube.com/watch?v=q6M1FumqeyMThe parasympathetic (freeze) response is tied to allergic and asthmatic reactionshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039300/Dr. Hhttps://www.craigheacockmd.comSupport the show

Is marijuana a medicine or a coping strategy?  Is it safer than alcohol, or in some people, much more risky? Does it help anxiety or does it trigger panic symptoms? This mini-episode explores the complex landscape of "medical" marijuana and what this looks like in Colorado.LinksMJ and psychosishttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033190/MJ as mania triggerhttps://www.ncbi.nlm.nih.gov/pubmed/25285897Adolescents and MJ-- increasing risk of developing psychosishttps://www.ncbi.nlm.nih.gov/pubmed/25774457https://www.psychiatryadvisor.com/home/topics/addiction/cannabis-use-disorder/cannabis-induced-psychosis-in-teenagers-and-young-adults-risk-factors-detection-management/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931552/CBDhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326553/Dr. Hhttps://www.craigheacockmd.comSupport the show

Sobriety can sometimes be a bridge too far. In a last ditch attempt to escape his methamphetamine-drenched life, Larry moved 1000 miles away to live with his father, he threw away his cell phone, gave up all drugs and alcohol, started running, got a good job...and found himself increasingly overwhelmed by the need to put a needle in his arm.His eventual solution wasn't perfect, but it may have saved his life. LinksHarm reductionhttps://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-6-35Marijuana and cognitionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037578/Suboxone/buprenorphinehttps://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphinehttps://www.vox.com/science-and-health/2017/7/20/15937896/medication-assisted-treatment-methadone-buprenorphine-naltrexoneSupport the show

This mini-episode explores some of the most frequently asked questions about ketamine: •What is ketamine?•How does it work?•Who responds best to ketamine?•What is the ketamine experience like?•What is the best way to do ketamine treatments?•What are the side effects/risks?•Who definitely shouldn't do ketamine?Interview with Dr. H about ketamine on Rural Emergency Medicine podcasthttps://www.ruralem.org/2019/03/07/episode-17-ketamine-revisited/Dr. H and Back from the Abysshttps://www.craigheacockmd.comSupport the show

Chris successfully hid his increasingly severe depression throughout middle and high school, but by his first year of college he could no longer ignore the horrifying signs that his brain was losing touch with reality. Inanimate objects began to radiate into his thoughts, and suicide seemed the only way to escape. Fortunately Chris took the scariest leap of all and began to open up to a therapist about what was happening in his mind, leading to an exploration of shame, a reformulation of the self, and finally the unexpectedly powerful healing of ketamine. Dr. H interview-- "Recognizing psychosis", on Rural Emergency Med podcasthttps://www.ruralem.org/2019/03/31/episode-18-recognizing-psychosis/Ketamine resources/informationhttps://www.kriyainstitute.comLinks-- Delaying treatment leads to worsening and more difficult to treat depressive, bipolar, and psychotic illnesshttps://www.nature.com/articles/mp201233https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608308/https://eurekalert.org/pub_releases/2018-02/cfaa-oyd022318.phphttps://www.nationalelfservice.net/treatment/systems/early-intervention-in-psychosis/outcomes-in-first-episode-manic-psychosis/https://www.sciencedirect.com/science/article/abs/pii/S0920996412004987Dr. H and Back from the Abysshttps://www.craigheacockmd.comSupport the show

A wise psychotherapy supervisor once said:  "There are only two things a therapist can do...hold...or poke...lots of therapists are good at holding...not so many are confident enough to poke...the good therapist has mastered the art of both."Actually, there are at LEAST 4-5 other crucial mental processes that an effective therapist should be doing more or less simultaneously...and that's no easy task.This mini-episode explores the hold vs poke dilemma, why this matters so much to anyone who has come to a therapist for meaningful change, and some tangible markers for whether your therapist is up for the challenge of you.Dr. Hhttps://www.craigheacockmd.comSupport the show

Ellie grew up in small town Montana and found a highly effective way to cope with the terrible pain of adolescence, family chaos, and depression. Unfortunately, her eating disorder took on a life of its own and almost destroyed her. This is her hero's journey, not of "recovery" per se, but rather of courage, grit, and fierce intention to construct a new self, and ultimately, find a path into the light.Resources on eating disordersBooksEating in the Light of the Moon by Anita JohnsonLife without ED by Jenni SchaeferSick Enough by Jennifer Gaudanihttps://www.nationaleatingdisorders.orgFor ketamine resources see episode 1 (Strawberries)Dr. Craig Heacock is an adolescent/adult psychiatrist and addiction specialist in Colorado. He was a co-therapist in the Phase 3 trial of MDMA-Assisted Psychotherapy for PTSD and has particular interest in the use of ketamine and other psychedelics to treat severe mood disorders and PTSD.  He is a graduate of the University of New Mexico School of Medicine and did his psychiatry training at Brown University.Dr. Hhttps://www.craigheacockmd.comSupport the show