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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Bringing Therapy into Med Management-- An intensive workshop for psych NPs and PAs, June 3-6 2026 in Ft Collins

https://www.craigheacockmd.com/bringing-therapy-into-med-management/

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

BFTA episode recommendations/Podcast page

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

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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

BFTA episode recommendations/Podcast page

https://www.craigheacockmd.com/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. 

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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

BFTA episode recommendations/Podcast page

https://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 Miller

https://payhip.com/peersupportformultiples

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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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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. 

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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.

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Rachael Parsons Svendsen

https://www.rachaelsvendsen.com/

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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This story is a mirror to Elizabeth’s story from season 1 episode 1. Today’s storyteller Sarah was so moved by Elizabeth’s story that it helped her to trust Dr. H's recommendation to take a pretty scary medication, the extremely powerful antipsychotic and mood stabilizer called clozapine. 

So why tell this story again? As they say, history doesn’t repeat itself, but it does often rhyme, and Sarah’s story rhymes beautifully with Elizabeth’s. Both had severe and treatment resistant bipolar 1 disorder, formerly known as manic-depression. Both tried all the meds, did all the things, then eventually reached a point of utter hopelessness and despair….and then they had to trust Dr. H enough to try one more thing.

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"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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In today’s story we explore what it’s like to be on the autistic spectrum, and more specifically, how a later life diagnosis can totally change the way you view the world and yourself. Aurelie, our storyteller today,  was an autism expert, a clinical psychologist who had trained with some of the premier autism experts in the country…yet she didn’t discover her own autism until she was 40 years old. 

This episode explores why women on the spectrum are so often missed, how women on the autistic spectrum are so often masters of masking, which means imitating the mannerisms and behaviors of neurotypical people, thus allowing them to both fit in and also to be left hiding in plain sight. 

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Dr. Aurelie Welterlin

https://www.ncawag.net/our-team/dr-aurelie-welterlin

"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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How do you rebuild trust amidst the ashes of trauma? This is the story of Sean, an up and coming star tennis player whose coach carefully selected him and then groomed him for years of sexual assault. His trust destroyed, Sean had to find a way to try to trust again…..and after many years of hiding and pretending and near self-destruction, Sean finally was able to share the details of what happened to him. Thus began his therapeutic journey of finding compassion for himself and trust toward others…with the guidance of his two devoted therapists and the assistance of MDMA.

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"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