Back from the Abyss: Psychiatry in Stories | Psychotherapy, Trauma, and Psychedelics

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 Ronken
https://www.inclusionrecovery.com

Dan's Youtube channel
https://www.youtube.com/user/danronken

Dr. H
https://www.craigheacockmd.com

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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. H
https://www.craigheacockmd.com

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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 Daine
http://www.dainepsychservices.com

Dr. H
https://www.craigheacockmd.com

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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 Abyss
https://www.craigheacockmd.com

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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. H
https://www.craigheacockmd.com

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In this second part of Saj's story, he continues to explore the transformative healing of his MDMA session. Initially believing his therapy journey to be complete,  his mother later develops terminal cancer and his attachment wounds reactivate. This impending loss leads him to seek even more advanced and difficult work with psilocybin and the support of two experienced guides in the Netherlands.

Saj further develops the idea that while psilocybin may well have major therapeutic potential, it is definitely not a starter psychedelic medicine, but rather one that requires significant psychological preparation and scaffolding in order to harness its power.

Saj Razvi and the Psychedelic Somatic Institute
https://www.psychedelicsomatic.org/

Dr. H
https://www.craigheacockmd.com

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This is the first of a two part very special interview with Saj Razvi, the Director of Education at Innate Path in Denver, CO. Saj weaves together his three fascinating perspectives— that of a nationally recognized trauma expert, his own personal story of early childhood neglect and how this shaped everything else to come, and finally his long journey of healing the deepest wound a person can have, eventually coming to MDMA and then psilocybin at the latter part of his therapy journey.

The episode starts with some foundational concepts in understanding trauma and its long term effects, then shifts to compare and contrast psychotherapy vs somatic therapies vs psychedelic assisted therapies (cannabis vs ketamine vs MDMA vs psilocybin).  Part 1 ends with Saj's life-changing MDMA therapy session and beautifully describes how MDMA might help people break through the dissociative legacy of complex PTSD and attachment trauma.

Saj Razvi and the Psychedelic Somatic Institute
https://www.psychedelicsomatic.org/

Dr. H
https://www.craigheacockmd.com

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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. H
https://www.craigheacockmd.com

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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 overview
https://www.nami.org/Learn-More/Mental-Health-Conditions/Borderline-Personality-Disorder/Overview

Lifetime course of BPD
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4500179/

Dr. H
https://www.craigheacockmd.com

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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.


Links
Complex PTSD and EMDR
https://www.goodtherapy.org/blog/complex-trauma-emdr-can-help-but-its-no-quick-fix-0425165

http://www.coping.us/images/Korn_2009_EMDR_with_PTSD.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5904704/

Dr. H
https://www.craigheacockmd.com

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