How to Be Patient

By popular demand, Margaret and Preston are back with another therapy episode. The topic this week? Acceptance and Commitment Therapy (ACT), a third wave behavioral therapy that Margaret happens to be trained in and love for her patients and her own life. In this episode we talk about the founder of ACT and its roots in behaviorism, what an ACT therapist “sounds like”, and the 6 core processes of psychological flexibility that encompass what this type of therapy does. Finally, Margaret and Preston go through their own values, and try to apply the ACT principles to two particular problems in their own lives. 

Resources:

Book for clinicians: ACT in Steps by Clarissa W. Ong, Michael E. Levin, and Michael P. Twohig

Book for all: The Happiness Trap by Russ Harris, ACT Made Simple by Russ Harris

Quick explanations from the ACT official website: https://contextualscience.org/the_six_core_processes_of_act

Citations:

Chapter cited for history/explanation of theory for ACT: Hayes, S.C., Strosahl, K.D., Bunting, K., Twohig, M., Wilson, K.G. (2004). What Is Acceptance and Commitment Therapy?. In: Hayes, S.C., Strosahl, K.D. (eds) A Practical Guide to Acceptance and Commitment Therapy. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-23369-7_1

Process Based Therapy: Hofmann SG, Hayes SC. The Future of Intervention Science: Process-Based Therapy. Clin Psychol Sci. 2019 Jan;7(1):37-50. doi: 10.1177/2167702618772296. Epub 2018 May 29. PMID: 30713811; PMCID: PMC6350520.
Encyclopedia of Cognitive Behavior Therapy: Editors: Arthur Freeman, Stephanie H. Felgoise, Christine M. Nezu, Arthur M. Nezu, Mark A. Reinecke.

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In this episode, we bring on Kristin Flanary, who is currently doing her own investigation into dissociations associated with trauma from both her own experience as a survivor and as an academic. We discuss the current media landscape of trauma and dissociation, the neurological mechanisms of dissociation, and therapeutic approaches clinicians can use with a patient who is experiencing dissociation.

Citations:

Modesti MN, Rapisarda L, Capriotti G, Del Casale A. Functional Neuroimaging in Dissociative Disorders: A Systematic Review. J Pers Med. 2022;12(9):1405. Published 2022 Aug 29. doi:10.3390/jpm12091405

Tisserand A, Philippi N, Botzung A, Blanc F. Me, Myself and My Insula: An Oasis in the Forefront of Self-Consciousness. Biology (Basel). 2023;12(4):599. Published 2023 Apr 14. doi:10.3390/biology12040599

McIntyre CK, McGaugh JL, Williams CL. Interacting brain systems modulate memory consolidation. Neurosci Biobehav Rev. 2012;36(7):1750-1762. doi:10.1016/j.neubiorev.2011.11.001

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Today we are joined by the host of the “calling in sick” a pod run by our good friend Alex (familiarly) to discuss the rigamoroll that is navigating the healthcare system through the eyes of a patient with debilitatig conditions. Alex shares her story from Investment banker, to patient to podcaster all the while coloring things with her own levity and resilience.

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This episode is a slight excursion from our regularly scheduled program. Today we are chatting with Will Flannery, who is in many ways our content “dad” if you will. We will talk about the art of including humor into our daily practive, when it goes right, when it goes left, and where we go from here. Dr. Glaucomflecken also has some fun and new projects he’d like to share with you at the end. 

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Margaret and I are back with part two of our conversation with Dr. Drew Ramsey and this time, things get personal. I volunteered my real-life food log for a full nutritional psychiatry breakdown… and let’s just say my “ultra-processed protein” lifestyle did not escape unscathed.

Takeaways:

Why your “perfect” diet might still leave you mentally drained and what to do about it.

The hidden emotional layers behind our food choices (yes, even that afternoon candy craving).

How protein obsession became a modern wellness trap and what real balance looks like.

The role of creativity, cooking, and joy in building true mental fitness.

Why self-care means more than nutrients, it’s about structure, connection, and staying alive in this work.

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We sat down with Dr. Drew Ramsey to talk about something we all think we understand and don’t: how food shapes mood. In Part 1, we get practical and personal: what to reach for when you’re anxious, what to cook when you’re depressed, and how to think about nutrition when you’re busy, broke, or just not in the headspace to sauté anything. We talk simple swaps, what actually belongs on a “brain food” plate, and why perfection is the enemy of getting fed.

Takeaways:

Start small, eat real: One or two consistent food changes beat any “perfect diet” you’ll abandon by Thursday.

Plates, not rules: Build a simple “brain-food plate” you can repeat—color, protein, fiber, healthy fat, then stop obsessing.

Shop for mood, not vibes: A short grocery list can be more stabilizing than another self-help book.

Cook your baseline: Have 2–3 “low-spoon” meals you can make when motivation is gone.

Progress over purity: The goal isn’t clean eating; it’s consistent nourishment your future self can rely on.

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In this preston-led episode, we take a deep dive into the history of lithium and its use in psychiatry. But because Preston is very literal, we are starting at the very beginning, inside of stars where lithium was formed at the beginning of the universe. Then we will follow this wonderful atom through history and past its FDA approval in 1970 to where we are today. 

Takeaways:

Lithium was once sold in Seven Up as a mood-lifting ingredient—but the consequences were messy.

A forgotten Australian psychiatrist helped launch lithium into psychiatry with groundbreaking trials.

Despite its toxicity risks, lithium remains the gold standard for reducing relapse and suicidality.

U.S. psychiatrists resisted lithium for decades—even as Europe embraced it.

Preston and Margaret debate lithium’s place today: miracle stabilizer or underused relic?

Citations:

https://www.sciencedirect.com/science/article/abs/pii/0025556484901160

Shorter E. The history of lithium therapy. Bipolar Disord. 2009 Jun;11 Suppl 2(Suppl 2):4-9. doi: 10.1111/j.1399-5618.2009.00706.x. PMID: 19538681; PMCID: PMC3712976.https://pmc.ncbi.nlm.nih.gov/articles/PMC3712976/

Fowler, Gene. Crazy Water: The Story of Mineral Wells and Other Texas Health Resorts. No. 10. TCU Press, 1991.

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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/

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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.
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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

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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

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