In this episode of “Psyched Perspectives,” host Frank A. Clark, MD, discusses trauma, transformations, and truth with colleague Emily Lafferman, MD. Lafferman shared a poem she wrote as a reflection on her transition and learning in psychiatry residency, called “Regalis Becoming.” Working together at Prisma Health, the two have a dedicated project to share insights in the psychiatrist experience beyond break room conversations. As a fellow poet, Clark shared his response poem, titled “A Genial Gift.” The themes the pair address through poetry provide a release, says Lafferman, and “the potential of my poem and my words to fall on seasoned ears is a feeling…it will resonate for others, especially those that have faced a lot of trauma themselves or worked with patients with trauma.” Discussion of therapeutic struggle or the clinician’s own dealings with personal trauma is something Clark and Lafferman tend to work through in their poetry.

Lafferman’s interest in trauma, transformation, and truth has been something she’s reflected on as a medical resident. Aware of the trauma psychiatrists confront quite often, she worked to identify why trauma may be so intimidating as a clinician. She found that she had a discomfort in herself that arose when assisting patients discussing their trauma. Yet, this could be a clinical tool for her to relate to her patients and colleagues. Lafferman notes that she took on the perspective on trauma that it can be something of a paradox, leaving patients wanting connection while feeling isolated.1

Clark adds that both he and Lafferman engage in therapy as patients, and knowing what it is like to “sit in the other chair” allows them to connect more strongly with both their patients and themselves. Clark references The Anxious Generation and the collective trauma that can occur in particular aspects of society.2 A constant news cycle with a focus on negativity and inundation of information can heighten the arousal of the amygdala, Clark points out.

Frank A. Clark, MD, in this installment of "Psyched Perspectives," a series in which he converses with his colleagues about the practice of psychiatry, sits down with Brittany Albright, MD, MPH, to talk about the often neglected topic of the intersection of sex and psychiatry, emphasizing the importance of addressing sexual health in psychiatric care. 

Albright, a Harvard-trained psychiatrist and founder of Sweetgrass Psychiatry, highlighted the neglected nature of sexual health in psychiatry and the need for better education and open conversations. Albright shared her personal experiences growing up in the 80s and 90s, where sex was stigmatized and the HIV epidemic was prevalent.

She wants to advocate for creating safe spaces for patients to discuss sexual adverse effects of medications. Psychiatric medications, including antidepressants and antipsychotics, can cause a range of sexual adverse effects, such as decreased libido, erectile dysfunction, and problems with orgasm.

"It is our ethical obligation to have these conversations with our patients, because the worst thing we can do is steal their humanity or make their depression worse by inflicting them with sexual dysfunction," said Albright. "It is our job to set up our patients for success and to provide them with a safe space to have these very challenging, taboo conversations."

When it comes to talking about sex with patients, Albright recommends trying to be as nonjudgmental and open as possible, and using nonstigmatizing language. Additionally, she always warns patients that certain medications could potentially cause sexual health adverse effects. While the risk is low, she still wants them to be aware that they could impact all areas of the sexual health cycle. If that does happen, she tells them to message her over the patient portal, as most patients feel less fear or anxiety in messaging about sexual health in that way. 

She also wished to stress the importance of a holistic approach that includes exercise, sleep, nutrition, and connectedness. Albright recommends patients utilize the Wild 5 program, which is a evidence-based, 30-day, no cost program that combines established wellness practices and positivity. Created by Saundra Jain, MA, PsyD, LPC, and Rakesh Jain, MD, the program is not specific to sexual health or to depression, but rather "specific to all of us as humanity." Its purpose it to enrich the patient's levels of happiness, enthusiasm, resilience, and optimism. 

Both Clark and Albright stress the need for advocacy at all levels to improve sexual health education and reduce the stigma around discussing sexual health.

"There is no normal, even when it comes to different genders," shared Albright. "It is important that we can provide sexual education to our patients, that what they are feeling is normal. It is important that we educate each other and communicate on these issues, and that we reassure our patients that they are normal and that they are enough."

Dr Clark is an outpatient psychiatrist at Prisma Health-Upstate and clinical associate professor at the University of South Carolina School of Medicine, Greenville. He served on the American Psychiatric Association’s Task Force to Address Structural Racism Throughout Psychiatry, and he currently serves as the Diversity and Inclusion section editor and advisory board member for Psychiatric Times.

Dr Albright is an adult, adolescent, and addiction psychiatrist and owner of Sweetgrass Psychiatry in Mount Pleasant, South Carolina, as well as an emergency medicine psychiatrist with the South Carolina Department of Mental Health.

In this episode of “Psyched Perspectives,” host Frank A. Clark, MD, speaks with Verena Rizg, MN, NP-PHC, founder of the first BIPOC-focused clinic in the Canadian Armed Forces and a pioneer of nurse practitioner-led care across federal prisons in Nova Scotia. The conversation centers on culturally and racially responsive care, and how clinicians can improve diagnostic accuracy by expanding their assessment vocabulary around race, culture, and migration.

Rizg describes how patterns she observed across health systems—disengagement from care, treatment nonadherence, and misdiagnosis—often reflected unrecognized race-based trauma rather than primary psychiatric pathology. She argues that clinicians frequently under-ask rather than "wrong-ask," avoiding culturally sensitive questions out of fear of using improper language, which stalls the therapeutic alliance, a known predictor of outcomes. She recommends techniques such as reflective repetition ("did I get that right?") to build trust, particularly with migrant and racialized patients.

The discussion covers physiological correlates of chronic race-based stress, such as persistent tachycardia, hypervigilance, hypertension, and eventual target-organ damage—framing racial trauma as a biopsychosocial issue, not solely psychological. Rizg also discusses incorporating "weathering" as an explicit risk factor in suicide risk assessments for patients from historically marginalized communities.

A central portion introduces Rizg's original framework, the "Cost of Capable," describing how overperformance in high-achieving individuals from marginalized or immigrant backgrounds is often rooted in survival rather than ambition, and manifests through invisibility, overexertion, and isolation. She connects this to burnout, difficulty resting, and delayed help-seeking, and discusses reframing resilience as sometimes masking unmet needs rather than something to be celebrated uncritically.

Other clinically relevant threads include: the therapeutic utility of asking patients (and clinicians) "What do you look like when you're well?" as a wellness barometer; integrating spirituality/meaning-making into treatment planning; and a candid disclosure by Rizg of her own previously undiagnosed attention-deficit/hyperactivity disorder, discussed in relation to underdiagnosis of neurodivergence in women, particularly Black women, due to high-functioning masking behaviors.

The episode closes on themes of clinician self-care, posttraumatic growth, and the idea that clinicians must "show up for themselves" before they can fully show up for patients.

Frank A. Clark, MD, in this episode of "Psyched Perspectives," sits down with Tiffani Bell Washington, MD, MPH, to talk about finding joy and balance as a psychiatric practitioner.

Washington is a quadruple board certified psychiatrist who specializes in child & adolescent and adult psychiatry, and obesity and lifestyle medicine. She is the founder of The Healthy Weigh MD and the Bell Well Joy Initiative, 2 platforms dedicated to helping high-achieving women experience joy, balance, and better health without burning out. She is also the host of the podcast "Joy in the Margin: Your Life the Healthy Weigh," which is designed for busy professionals, physician moms, and anyone looking to redefine wellness. Bell will graduate with her MBA from Yale University in May 2025 and is also a mother of 5.

Washington was inspired to start the podcast by her own desire to do something long-lasting with purpose, despite her busy schedule, to help inspire others to get started. It helped focus her energy on helping others, she shares.

She has found her work with children to be an incredible inspiration: "What I love most about child psychiatry is the resilience that's sort of built into children... Finding a way to find joy in the things that you're going through, and building that joy, despite what your life looks like, is something that's really motivating to me. I wanted to share it with others as well."

Psychiatrists and clinicians are often very focused and can easily become burned out, giving all of their energy to helping others. According to the American Medical Association, over 45% of physicians reporting at least 1 symptom of burnout. Glimpses of joy, not unlike the ones they felt as children, can help them grow and heal.

"Find something you enjoy and let it grow," said Washington. "That is the premise behind 'Joy in the Margin.'"

One research report shares that 45% of individuals have not felt true happiness for more than 2 years, and 25% do not know or have forgotten what it means to feel truly happy. Washington's driving message, to find joy in small things and then expand it, could help combat this rising wave of unhappiness.

In the first installment of "Psyched Perspectives," a series in which he will converse with his colleagues about the practice of psychiatry, host Frank A. Clark, MD, sits down with Jessica Obeysekare, MD, to discuss parental leave. When interviewing patients who are soon to be parents, Clark and Obeysekare find that many express anxiety, specifically anxiety around work. Can they take time off? How much time off do they receive? Should they quit their job and try to find another? How would such a decision impact their benefits?

Obeysekare is a psychiatrist at Prisma Health. She trained at Brown University for medical school and residency, and is board certified in psychiatry and addiction medicine. She is a clinical assistant professor at the University of South Carolina School of Medicine Greenville and Clemson University School of Health Research. She is also the associate program director for the Greer Psychiatry Residency program.

In 1993, the Family and Medical Leave Act (FMLA) was passed. This is a federal law that allows eligible employees to take unpaid, job-protected leave for certain family and medical reasons, including birth and care of a newborn, adoption or foster care, caring for a family member with a serious health condition, or an employee's own serious health condition. However, in order to receive FMLA time, employee's must meet certain conditions. In 2018, only 56% of US employees were eligible. It then becomes the employee's responsibility to find ways to spend time with a new baby, including state policies, choosing to work at companies that offer paid leave, utilizing sick or vacation days, and more.

"Families that make less money are less likely to qualify for FMLA," said Obeysekare. "The other thing is, with unpaid leave, when you see unpaid leave expansions, the people who benefit from that psychologically are people who can afford to take more unpaid leave. So it's really a luxury to able to take more time not getting paid, away from work."

According to Obeysekare, research shows that work leave lasting less than 12 weeks is associated with increased rates of postpartum depression. If, at the 4 month mark, the parent really wants to go back to work, research shows it is better for mental health to return to their job. 

The duo suggest that mental health and business must work together at a state and federal level to form a partnership, one that cares both about family happiness and economic outcomes. Cost of pregnancy, employee turnover, and other factors will be important considerations. 

Talking about parental leave early on with patients could help improve outcomes. Creating a plan, especially one that focuses on sleep for parents, is important. Talking openly and freely about this topic is beneficial for patients.