Back from the Abyss: Psychiatry in Stories

Dr. H dives deep into a patient's scary, confusing, and ill-advised list of psych meds to illustrate some deeper truths and lessons about psychopharmacology and the med management model of psychiatry.
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A listener-built, human-curated index of every Back From The Abyss episode to help you find themes, topics, and episode formats of interest.
Best viewed on a laptop or desktop (not mobile).
Content Catalog (in Google Sheets): https://bftapod.short.gy/index
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Dr. H sits down with Dr. Elizabeth Fenstermacher, Medical Director of the TMS Clinic at the University of Colorado- Anschutz to explore the growing role of TMS and neuromodulation in psychiatry.  They explore questions such as:
•How should we think about TMS vs ketamine in the treatment of depression? Trauma? OCD?
•Who are the best candidates for TMS? 
•What are the relative merits of intensive TMS (SAINT) vs standard protocols?
•How might TMS and ketamine work together to promote psychiatric stability?
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Dr. Elizabeth Fenstermacher
https://som.cuanschutz.edu/Profiles/Faculty/Profile/33013
Patient selection for TMS- Case report with Dr. Fenstermacher
https://journals.lww.com/hrpjournal/fulltext/2025/11000/case_report__personalizing_transcranial_magnetic.3.aspx
Explore the full BFTA Content Catalog:
A listener-built, human-curated index of every Back From The Abyss episode to help you find themes, topics, and episode formats of interest.
Best viewed on a laptop or desktop (not mobile).
Content Catalog (in Google Sheets): https://bftapod.short.gy/index

"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 page
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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.

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Explore the full BFTA Content Catalog:
A listener-built, human-curated index of every Back From The Abyss episode to help you find themes, topics, and episode formats of interest.
Best viewed on a laptop or desktop (not mobile).
Content Catalog (in Google Sheets): https://bftapod.short.gy/index

"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 page
https://www.craigheacockmd.com/podcast-page/

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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
Explore the full BFTA Content Catalog:
A listener-built, human-curated index of every Back From The Abyss episode to help you find themes, topics, and episode formats of interest.
Best viewed on a laptop or desktop (not mobile).
Content Catalog (in Google Sheets): https://bftapod.short.gy/index

"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 page
https://www.craigheacockmd.com/podcast-page/

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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 Miller
https://payhip.com/peersupportformultiples
Support the show! 
https://www.buzzsprout.com/396871/support
Explore the full BFTA Content Catalog:
A listener-built, human-curated index of every Back From The Abyss episode to help you find themes, topics, and episode formats of interest.
Best viewed on a laptop or desktop (not mobile).
Content Catalog (in Google Sheets): https://bftapod.short.gy/index

"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 page
https://www.craigheacockmd.com/podcast-page/

Support the show