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

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.


Links
EMDR (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 PTSD
https://www.youtube.com/watch?v=q6M1FumqeyM

The parasympathetic (freeze) response is tied to allergic and asthmatic reactions
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039300/

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

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Is cannabis 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.


Links
Cannabis and psychosis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033190/

Cannabis as mania trigger
https://www.ncbi.nlm.nih.gov/pubmed/25285897

Adolescents and Cannabis-- increasing risk of developing psychosis
https://www.ncbi.nlm.nih.gov/pubmed/25774457

https://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/

CBD
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326553/

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

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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.


Links
Harm reduction
https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-6-35

Marijuana and cognition
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3037578/

Suboxone/buprenorphine
https://www.samhsa.gov/medication-assisted-treatment/treatment/buprenorphine

https://www.vox.com/science-and-health/2017/7/20/15937896/medication-assisted-treatment-methadone-buprenorphine-naltrexone

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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 podcast
https://www.ruralem.org/2019/03/07/episode-17-ketamine-revisited/

Dr. H and Back from the Abyss
https://www.craigheacockmd.com

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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 podcast
https://www.ruralem.org/2019/03/31/episode-18-recognizing-psychosis/

Ketamine resources/information
https://www.kriyainstitute.com

Links-- Delaying treatment leads to worsening and more difficult to treat depressive, bipolar, and psychotic illness
https://www.nature.com/articles/mp201233

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608308/

https://eurekalert.org/pub_releases/2018-02/cfaa-oyd022318.php

https://www.nationalelfservice.net/treatment/systems/early-intervention-in-psychosis/outcomes-in-first-episode-manic-psychosis/

https://www.sciencedirect.com/science/article/abs/pii/S0920996412004987


Dr. H and Back from the Abyss
https://www.craigheacockmd.com

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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. H
https://www.craigheacockmd.com

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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 disorders

Books
Eating in the Light of the Moon by Anita Johnson
Life without ED by Jenni Schaefer
Sick Enough by Jennifer Gaudani

https://www.nationaleatingdisorders.org


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

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In this very first episode of BFTA we explore one of the most frightening parts of the abyss, coming face to face with the desperate need to die. Elizabeth woke up five days after her near fatal suicide attempt and found herself with another chance--  this is her story of finding a new way to live and be in this world.

Helpful websites on:

Bipolar disorder
https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Clozapine
https://www.ncbi.nlm.nih.gov/pubmed/25346322

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30081-5/fulltext

https://www.ncbi.nlm.nih.gov/pubmed/7883728

Ketamine
https://www.knowablemagazine.org/article/mind/2019/listening-ketamine

https://www.scientificamerican.com/article/getting-the-inside-dope-on-ketamine-rsquo-s-mysterious-ability-to-rapidly-relieve-depression/

https://www.ncbi.nlm.nih.gov/pubmed/28749092

Dr. H and Back from the Abyss
https://www.craigheacockmd.com

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.

Support the show