Psychofarm Podcast

You Can See Everything is one of the strangest films about Elizabeth Holmes yet, and in this episode two psychiatrists try to make sense of it. We explore what Nathan Fielder’s interviews bring out in Holmes and Billy Evans, from unusual facial expressions and her distinctive voice to the couple’s intense descriptions of love. Using psychoanalytic concepts such as narcissism, splitting, borderline personality organization, identity diffusion, and the “as-if personality,” we examine how people construct a sense of self and why someone might defend a version of reality that others find impossible to believe. We also ask what documentaries actually let us know about people, and how much of what we see is our own projection. Spoilers throughout.

Antipsychotic medications are not interchangeable, and the tradeoffs between efficacy, metabolic burden, movement side effects, sedation, and adherence can be huge. In this episode, we build an antipsychotic tier list and rank medications including clozapine, olanzapine, haloperidol, risperidone, lurasidone, quetiapine, aripiprazole, and more. Along the way, we connect receptor pharmacology to practical clinical pearls, including food requirements, smoking effects, prolactin, akathisia, EPS, weight gain, long-acting injectables, and clozapine monitoring. We also discuss how medication choice shifts across schizophrenia, bipolar disorder, bipolar depression, and mood symptoms.

PTSD diagnosis is more complicated than identifying a trauma history. In this episode, we break down what qualifies as Criterion A trauma, the major PTSD symptom clusters, and how intrusion, avoidance, negative beliefs, hyperarousal, and dissociation can show up in practice. We also discuss acute stress disorder, fragmented traumatic memory, and why PTSD can be mistaken for depression, anxiety, mania, concentration problems, or psychosis. Along the way, we focus on careful trauma assessment: establishing a timeline, considering alternative diagnoses, monitoring the patient’s level of distress, and gathering what you need without turning a diagnostic interview into trauma therapy.

What should patients know when they are diagnosed with depression? In this episode, psychiatrists Dr. Malzberg and Dr. Fu cover what they wish every patient knew from the start. They explain why a depression diagnosis is a useful shorthand rather than a fixed identity, how biological, psychological, and social factors feed into each other, and how medication, therapy, and lifestyle changes work together. You will hear practical first steps like behavioral activation, a steady wake time, morning sunlight, and cutting back on alcohol and cannabis, plus what to do if treatment stalls and how to decide who to tell. It is an hour of clear psychoeducation for patients and a resource clinicians can share.

Autism diagnosis is more complicated than recognizing a handful of autistic traits. In this episode, Dr. Fu and Dr. Malzberg unpack the DSM-5-TR criteria for autism spectrum disorder, including social communication differences, restricted and repetitive behaviors, developmental onset, impairment, and Levels 1–3. They then tackle one of the hardest parts of adult autism assessment: differential diagnosis, including overlap with ADHD, schizophrenia, and personality disorders. The conversation also explores theory of mind, masking, the double empathy problem, weak central coherence, and the empathizing-systemizing framework. The goal is a more clinically useful way to think about what distinguishes autistic traits from autism spectrum disorder and why developmental history matters.

Diagnosing bipolar disorder is rarely as simple as finding a clear episode of hypomania. Dr. Phelps explains why bipolarity is better understood across a mood spectrum and walks through the clues that can help distinguish bipolar depression from unipolar depression: age of onset, family history, course of illness, treatment response, cyclicity, and collateral history. We also dig into mixed states, the “four A’s” of anxiety, anger, agitation, and attention problems, antidepressant activation, the HCL-32, and the Bipolarity Index. The larger theme is diagnostic humility: uncertainty is often appropriate, and treatment decisions should reflect both the strength of the evidence and the risks of getting the diagnosis wrong.

Lindsay Clancy’s insanity defense is the focus of this forensic psychiatry follow-up after the mistrial. We revisit the case through the lens of legal insanity, postpartum psychosis, malingering, criminal responsibility, and the difference between a legal conclusion and a moral judgment. We also discuss why psychosis cannot be reduced to a single reported voice, how forensic psychiatrists think about exaggeration versus malingering, questions around expert testimony and diagnosis, and the relationship between psychosis and violence. Finally, we look at medication nonadherence, culpability, how uncommon the insanity defense may be, and what questions arise when someone is found not guilty by reason of insanity.

Lindsay Clancy postpartum psychosis and the insanity defense are examined through a forensic psychiatry lens in this episode. We discuss how psychiatrists distinguish psychosis from malingering, whether someone can be psychotic while still appearing organized, command hallucinations, delusions, altruistic filicide, and what criminal responsibility actually asks. We also look at Dr. Philip Resnick’s testimony, Clancy’s psychiatric treatment, fragmented care, collateral information, and the limits of ruling out bipolar disorder after a brief evaluation. Finally, we explore why the case has produced such intense public reactions and why psychiatry often requires tolerating uncertainty rather than forcing complex patients or cases into simple categories.

Affective neuroscience in psychiatry may offer a better way to understand patients who do not fit neatly into DSM categories. Dr. White joins us to explain Jaak Panksepp’s seven primary emotional systems, the difference between affect and emotion, and how subcortical emotional arousal interacts with cortical regulation. We discuss anger, borderline personality disorder, cognitive decline, mindfulness, ACT, emotional blunting with SSRIs, and why some cases labeled treatment-resistant depression may need a better formulation rather than another medication. We also get into the neuroscience behind the model… from decortication and brain-stimulation studies to TMS… and ask what psychiatry loses when diagnosis comes before understanding affect.Dr. White’s Substack:

We put the Seinfeld cast on the proverbial couch, not to slap diagnoses on fictional characters, but to show why personality formulation can tell us far more than a psychiatric label.

Is George a vulnerable narcissist, borderline, or something more complicated? Does Jerry’s obsession with cleanliness and order actually resemble OCD or an obsessive-compulsive personality style? Could Kramer meet criteria for antisocial personality disorder despite being charming, affectionate, and largely nonviolent? And is Elaine secretly the healthiest person in the group?

Along the way, we explore flanderization, narcissism, borderline personality organization, obsessive-compulsive personality traits, psychopathy versus antisocial personality disorder, gambling disorder, and the DSM-5 Alternative Model for Personality Disorders.