Back from the Abyss: Psychiatry in Stories

There is a growing awareness in psychiatry that not all psychiatric illness is psychiatric— some percentage of what presents in psychiatric settings is actually triggered by autoimmune responses to various pathogens and insults.  In the late '90s a syndrome called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with strep) came on the scene with cases of sudden onset OCD and tics that appeared in conjunction with strep infections. The theory behind PANDAS was that parts of the basal ganglia of the brain had exterior cell proteins which were very similar to those of the strep bacteria, and as the immune system began to attack the strep bacteria, it also began an autoimmune assault on parts of the midbrain, including the basal ganglia, thus producing a sudden onset of OCD or tics.In recent years PANDAS has evolved into a broader concept called PANS— pediatric acute onset neuropsychiatric syndrome— which includes a vast array of neurological and psychiatric symptoms and syndromes that can potentially be triggered by autoimmune reactions. It can be tricky to diagnose PANS….this is probably why it is still a somewhat controversial diagnosis in some arenas. We don’t have a clear and consistent set of labs or biomarkers to positively determine PANS, and because the syndrome is so broad in how it can present, clinicians struggle to come up with a modal or average presentation that they can put in their pattern recognition systems. One feature that seems fairly classic for PANS is that the symptoms tend to increase during and/or right after a concomitant infectious illness, presumably because the immune system activation is reigniting the autoimmune attack on the central nervous system.Today’s story features a mom, Kari, and her daughter, Zoe. Zoe had lots of illness and immune system issues as a young child, first fatigue and then GI symptoms, then profound mood instability, and then she eventually developed horrific treatment resistant anorexia which did not respond to the best treatments psychiatry had to offer.Support the show! https://www.buzzsprout.com/396871/support"I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/BFTA episode recommendations/Podcast pagehttps://www.craigheacockmd.com/podcast-page/Support the show

Psychotherapy can often get stuck in a there and then storytelling mode....how do we shift the therapeutic encounter into the immediacy of the Here and Now?  Here Dr. H shares 10 questions which shine a spotlight on what's happening (and not happening!) between therapist and patient. Support the show! https://www.buzzsprout.com/396871/support"I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/BFTA episode recommendations/Podcast pagehttps://www.craigheacockmd.com/podcast-page/Support the show

Dr. H sits down with Jade Miller, a peer support specialist and advocate for public education about DID (Dissociative Identity Disorder). In the first part of this episode, Jade shares her story and how she came to understand that the puzzling gaps and often frightening incongruities in her life were caused by her rotating through a number of dissociated identities or alters, initially protecting her… but eventually leaving her powerless to stop repeated traumatization.  Jade and Dr. H then talk shop about DID and Jade challenges some of Dr. H's long held beliefs.Jade Millerhttps://payhip.com/peersupportformultiplesSupport the show! https://www.buzzsprout.com/396871/support"I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/BFTA episode recommendations/Podcast pagehttps://www.craigheacockmd.com/podcast-page/Support the show

BFTA storyteller Frank shares the joy, confusion, chaos, utter fear, and deepest gratitude when he and his partner Brad adopted and raised two boys, ages 4 and 2, from the foster care system. Twenty years ago, when Frank adopted the boys, trauma was not in the public awareness as it is today, and he was told that these little boys, who had spent some time in a meth house, might well have some challenges…..but he never could have expected what awaited.Can love overcome trauma? Can stability and structure and patience and compassion adequately compensate for profound early childhood neglect and abuse?  Frank’s story is just one example, but it’s a beautiful one, these two dads trying to find a way to heal deep attachment wounds without a roadmap. Support the show! https://www.buzzsprout.com/396871/supportBFTA episode recommendations/Podcast pagehttps://www.craigheacockmd.com/podcast-page/Support the show

Rachael, a trauma therapist and today's storyteller, describes how her early childhood abuse was buried by the protective mechanism of dissociative amnesia.  As Rachael wrote to Dr. H, “The only way I could continue to live, with no way out, with no one to tell, with no words even to describe what was happening to me, was to forget what was happening to me….when our minds forget, our bodies remember.”Rachael saved herself by forgetting, then was forced to finally face what happened to her when her body carried out its ultimate rebellion in the context of having her third child, her first girl….a little baby girl, with no one to protect her….or at least that’s what the terrible and unrelenting obsessions began to say.Support the show! https://www.buzzsprout.com/396871/supportRachael Parsons Svendsenhttps://www.rachaelsvendsen.com/"I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/BFTA episode recommendations/Podcast pagehttps://www.craigheacockmd.com/podcast-page/Support the show