This week, Margaret and I sat down with Dr. Jhilam Biswas, psychiatrist and expert on the intersection of law and mental health, for one of the hardest—and most important conversations we’ve had on the show. Together, we take a close look at how our justice system responds to mental illness: what happens when people in crisis are incarcerated instead of cared for, and how the prison system has become a stand-in for mental health treatment in the U.S.

Dr. Biswas helps us unpack the reality of solitary confinement, forced treatment, and the impossible choices clinicians face when caring for patients inside a system built for punishment, not healing. Alongside Margaret, I reflect on the human cost—on families, on providers, and on the people trapped in cycles of crisis and incarceration.

This isn’t just a policy issue—it’s a deeply personal one. And it’s urgent.

Takeaways:

The prison system has become the de facto mental health provider—and it’s failing people in crisis.

Solitary confinement and punishment often substitute for care, especially when individuals are suicidal.

Clinicians face impossible ethical dilemmas, forced to provide care within systems that perpetuate harm.

Alternatives to incarceration exist, but remain underfunded and underutilized.

Reimagining justice requires reimagining care—building systems that prioritize treatment, not punishment.

Citations:

Biswas J, Drogin EY, Gutheil TG. Treatment Delayed is Treatment Denied. J Am Acad Psychiatry Law. 2018 Dec;46(4):447-453. doi: 10.29158/JAAPL.003786-18. PMID: 30593474.

Biswas J. Dignity restored: the power of treatment first. CNS Spectr. 2024 Dec 23;30(1):e11. doi: 10.1017/S109285292400052X. PMID: 39714025.

Advocacy: 

⁠https://www.psychiatry-mps.org/⁠

Jhilam Biswas:

Dr. Biswas Website:

https://psychexpertise.com/

https://www.neuroethicscollege.org/

--

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠⁠⁠⁠

Learn more about your ad choices. Visit megaphone.fm/adchoices

What is aphasia, really and what happens when your brain no longer cooperates with your ability to speak or understand language? In this episode, Preston and Margaret tackle the messy, frustrating, and often isolating world of language disorders, focusing on the real-life implications of aphasia.

They walk through the clinical causes, what it looks like day-to-day, and how aphasia differs from other speech and cognitive issues. Along the way, they share stories of miscommunication, explore the frustrations of being misunderstood, and dig into how patients and clinicians can better work together when words are hard to find.

Takeaways:

Aphasia isn’t about intelligence—it’s about access.

There’s more than one kind of aphasia—and none of them are simple.

Communication breakdowns aren’t just frustrating—they’re isolating.

Not all “word-finding problems” are created equal.
.

Listening might be the most important clinical skill we overlook.

Citations:

Main paper discussed during episode: https://pmc.ncbi.nlm.nih.gov/articles/PMC2854959/pdf/jcn-2-149.pdf

Aphasia and the Diagram Makers Revisited: an Update of Information Processing Models Kenneth M. Heilman, M.D. The James E. Rooks Jr. Distinguished Professor, Department of Neurology, University of Florida College of Medicine, and VAMC, Gainesville, Florida

--

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠⁠⁠

Learn more about your ad choices. Visit megaphone.fm/adchoices

Is it all in your head or is pain more complex than we’ve been led to believe? In this episode, Margaret and I dig into the psychological and biological factors that shape our experience of pain, including how the brain processes physical discomfort, the emotional toll it takes, and what role medications actually play. We also share stories from our own lives and clinical work that highlight how pain shows up in complicated, often misunderstood ways. If you've ever wondered why your body hurts when your heart is breaking, or why painkillers don’t always work, this one’s for you.

Takeaways:

Is pain really all in your head—or is that just part of the story?

How much of pain is physical, and how much is psychological?

Can we rewire the way we experience pain?

Why don’t medications always work the way we expect for pain relief?

What does it mean to treat pain with both compassion and science?

Citations:

Stanford and ACPA Chronic Pain guide 2024:

https://www.acpanow.com/uploads/9/9/8/3/99838302/acpa_stanford_resource_guide_2024.pdf

--

Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.

--

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠⁠

Learn more about your ad choices. Visit megaphone.fm/adchoices

Margaret took the captain’s chair for this one, and I was just along for the ride—straight into the deep waters of psychodynamic and psychoanalytic therapy. We start with the basics: what do these words actually mean, and why do they still make some clinicians roll their eyes while others swear by them? From Freud’s infamous couch to modern relational therapy, we unpack the myths, the methods, and the mysteries that still define this approach.

Along the way, we wrestle with big questions: What’s really happening in the therapeutic relationship? Why does transference matter? And is there value in a therapy that sometimes feels more like philosophy than science?

And because talking about it wasn’t enough, we try it on for size—running a live role-play where I attempt a psychodynamic formulation in real time. (Spoiler: it’s as messy and awkward as you’d imagine, but also revealing in ways I didn’t expect.)

This isn’t a lecture or a history lesson. It’s us exploring why psychodynamic therapy still sparks curiosity, skepticism, and maybe even wonder—and asking what it means for the future of how we help people heal.

Takeaways:

Therapy on the Couch: Why psychoanalysis still matters, even if we roll our eyes at Freud.
The Mirror Effect: How transference and countertransference shape every session more than we realize.

Cracks in the Foundation: Why psychodynamic work digs into the “basement” instead of just fixing surface problems.
Between Science and Story: The tension between falsifiability and the lived experience of patients.

Practice Makes Awkward: A live role-play that shows just how messy (and revealing) this approach can be.

Citations:

Kassaw K, Gabbard GO. Creating a psychodynamic formulation from a clinical evaluation. Am J Psychiatry. 2002 May;159(5):721-6. doi: 10.1176/appi.ajp.159.5.721. PMID: 11986123.

Summers, R. F., Barber, J. P., & Zilcha-Mano, S. (2024). Psychodynamic therapy: A guide to evidence-based practice (2nd ed.). The Guilford Press. Chapter 1 cited

--

Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.

--

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠⁠

Learn more about your ad choices. Visit megaphone.fm/adchoices

This episode might feel like a gut punch, in the most important way. Margaret and I sat down with Alyson Stoner to talk about what it means to be raised in the spotlight, what happens when systems prioritize performance over people, and how we reckon with that legacy in healthcare. There’s a vulnerability here that caught me off guard and I think that’s the point. If you’ve ever wondered what lies beneath the polished performances we all grew up watching, this one’s for you.

Takeaways:

The Performance Trap: We unpack how young performers are trained to suppress needs for the sake of applause—and what that does long term.

Behind the Curtain: Alyson shares a raw, unfiltered look at what fame masked, and what it demanded.

Trauma in the Body: We explore how unresolved pain shows up in physical health—and how the body never really forgets.

Reclaiming Identity: From child star to advocate, Alyson walks us through the messy, powerful work of redefinition.

What Healing Can Look Like: It's not about fixing—it’s about reconnecting. And sometimes the most honest therapy isn’t clinical at all.

Want more Alyson Stoner:

IG: @alysonstoner

TikTok: @alysonstoner

YouTube: @TheRealAlysonStoner

Citations:

Orenstein GA, Lewis L. Erikson's Stages of Psychosocial Development. [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556096/

--

Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.

--

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠

Learn more about your ad choices. Visit megaphone.fm/adchoices

Margaret and I sat down to speak on a topic we rarely hear spoken plainly: suicide. We didn’t plan to tidy anything up or wrap it in easy language. Instead, we tried to sit with it—the fear, the responsibility, the human ache behind it all. We talk about how suicide shows up in our clinical work, how it’s shaped us personally, and why we both believe silence helps no one. This isn’t a “how-to” or a lecture. It’s a real conversation between two people trying to hold space for pain, and maybe offer a little hope in the process.

Takeaways:

Let’s Start with the Silence – We unpack why suicide feels unspeakable in both professional and personal spaces.

The Weight of the Question – Margaret and I talk about what it’s like when someone asks, “Are you thinking about hurting yourself?”

Clinician Meets Human – We explore the blurry line between being the helper and being the one in crisis.

Words That Don’t Fix But Still Matter – Sometimes just saying “I’ll sit with you” carries more power than advice.

Not a Lesson—A Lived Experience – This episode isn’t scripted or solved. It’s honest, messy, and real.

Citations:

Margaret’s Discussion portion and most referenced informed by review ch: Kaplan and Sadock’s Comprehensive Textbook of Psychiatry, Volume 11, 2025 Published. Chapter 31.1: Psychiatric Emergencies: Suicide Overview, Risk and Protective Factors, Treatment, and Prevention

Suicide Crisis Syndrome Reference: Melzer, L., Forkmann, T., & Teismann, T. (2024). Suicide Crisis Syndrome: A systematic review. Suicide and Life-Threatening Behavior, 54, 556–574. https://doi.org/10.1111/sltb.13065

--

Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.

--

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠⁠

Learn more about your ad choices. Visit megaphone.fm/adchoices

This episode felt like a deep exhale. Margaret runs solo today, as she sat down with Dr. Hillary McBride—psychologist, author, and researcher—to talk about embodiment, trauma, and the radical act of tuning back into ourselves.

We talked about what it means to feel your feelings in your body, why disconnection often begins as protection, and how pleasure, presence, and play can be part of the healing process. It’s about more than coping. It’s about coming home.

This one surprised me, and stayed with me. I think it might do the same for you.

Takeaways:

Embodiment isn’t about perfection—it’s about presence.

Disconnection from the body is often a trauma response we learned for survival.

Reconnecting with your body can feel foreign, even frightening—and still be worth it.

Healing doesn’t always mean “feeling better”—sometimes it just means feeling.

Your body can be a place of safety, wisdom, and even joy—but you don’t have to rush to get there.

--

Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.

--

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: ⁠⁠⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com⁠

Learn more about your ad choices. Visit megaphone.fm/adchoices

While in psychiatry we avoid using declarative or certain language about mechanisms, it can be helpful to think about the narratives that drive people to behavior that will ultimately end their life. In this episode Margaret and I review the Durkheim principles of suicidality following the four categories: anomic, fatalistic, egoistic and altruistic. We talk about how each has a distinct flavor in the clinical setting and which ones are better handled by safety planning or solution based interventions.

Learn more about your ad choices. Visit megaphone.fm/adchoices

It’s Part 2 of our deep dive into eating disorders—and this time, we’re going even deeper. We kick off by unpacking our mock therapy session with Dr. Helen Liljenwall, which unexpectedly hit close to home for all of us. Then we take a sharp turn into the medical realities of starvation, including refeeding syndrome, the female athlete triad, and why your heart is always in the equation (literally).

But what happens when patients refuse to eat—and we have to decide whether they need a psychiatric hold? Who gets to say when a person with an eating disorder has lost capacity? And is “terminal anorexia” a compassionate truth—or a dangerous excuse?

If you’ve ever wondered what it really takes to treat eating disorders, this is the episode to hear. It's raw, real, and it doesn’t flinch.

Takeaways:

Refeeding syndrome isn’t just a med school concept—it’s a real, life-threatening danger in eating disorder treatment.

Psychiatric holds for anorexia raise tough ethical questions about autonomy, capacity, and what it means to save a life.

That fake therapy session? It’s not so fake when the emotional stakes are this high.

The eating disorder voice can sound like discipline—but it’s often masking deep distress.

Terminal anorexia is a controversial idea… and we don’t shy away from the controversy.

--

Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.

--

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: ⁠⁠⁠⁠⁠⁠⁠howtobepatientpod.com

Learn more about your ad choices. Visit megaphone.fm/adchoices

This is Part 1 of our two-part deep dive into eating disorders—and we’re starting at the beginning. Margaret and I sit down with psychiatrist and eating disorder specialist Helen Liljenwall, MD to walk through the basics: What are the major types of eating disorders? What do they actually look like in real life? And how do we treat something that’s rooted in both biology and culture? We cover everything med school skipped—then try to practice what we’ve learned in a fake (but emotionally real) therapy session with Dr. Helen as the patient. Spoiler: it got uncomfortable in all the right ways.

Takeaways:

Eating disorders don’t come with a single look—or a single diagnosis. We break down the ones you’ve heard of and the ones you haven’t.

Every med student should hear this conversation. Because we weren’t taught how to spot this stuff—let alone treat it.

Practicing therapy with an expert in the “patient” seat is more terrifying than it sounds.

This isn’t just about food. It’s about fear, shame, and survival strategies.

We’re not pretending to know everything. We’re starting with the basics—so we can learn to do better.

--

Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.

--

Watch on YouTube: @itspresro

Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.

—

Produced by Dr Glaucomflecken & Human Content

Get in Touch: ⁠⁠⁠⁠⁠⁠howtobepatientpod.com

Learn more about your ad choices. Visit megaphone.fm/adchoices