Back from the Abyss: Psychiatry in Stories

Kari reconnected with her birth mother in her 40s and finally began to understand the suffering for which she had no words. This is a story of adoption and reunification, of forgetting and remembering, of finding a truth without words in the wisdom of the body.  Kari’s birth mother was able to see something deep in Kari that she had never had words for….and thus began her path toward healing.
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Bringing Therapy into Med Management-- An intensive workshop for psych NPs and PAs, June 3-6 2026 in Ft Collins
https://www.craigheacockmd.com/bringing-therapy-into-med-management/
"I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference and countertransference with Dr. H and Dr. Hillary McBride, June 18-20 2026 in Vancouver BC
https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/
Elemental Psychedelics Ketamine-Assisted Psychotherapy Training
https://www.elementalpsychedelics.com/ketaminetraining
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Kate started her addiction journey at a young age, using substances as a salve for her terrible grief. Later, drugs and alcohol helped her to cope with the transition to nursing and the unending demands of a hospital setting.  But as with all addicts, this strategy worked until it didn’t….Kate eventually had to find a new way to cope if she was going to survive past her 30s.
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Kate Gibson (The Coleman Institute)
[email protected]; [email protected]
Bringing Therapy into Med Management-- An intensive workshop for psych NPs and PAs, June 3-6 2026 in Ft Collins
https://www.craigheacockmd.com/bringing-therapy-into-med-management/
BFTA on IG @backfromtheabysspodcast
https://www.instagram.com/backfromtheabysspodcast/
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Dr. H dives deep into a patient's scary, confusing, and ill-advised list of psych meds to illustrate some deeper truths and lessons about psychopharmacology and the med management model of psychiatry.
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Bringing Therapy into Med Management-- An intensive workshop for psych NPs and PAs, June 3-6 2026 in Ft Collins
https://www.craigheacockmd.com/bringing-therapy-into-med-management/
Explore the podcast through themes, domains, formats, and speakers.
The BFTA CODEX is a listener-built and curated field guide to every episode.
https://bfta-codex.org
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Dr. H sits down with Dr. Elizabeth Fenstermacher, Medical Director of the TMS Clinic at the University of Colorado- Anschutz to explore the growing role of TMS and neuromodulation in psychiatry.  They explore questions such as:
•How should we think about TMS vs ketamine in the treatment of depression? Trauma? OCD?
•Who are the best candidates for TMS? 
•What are the relative merits of intensive TMS (SAINT) vs standard protocols?
•How might TMS and ketamine work together to promote psychiatric stability?
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Dr. Elizabeth Fenstermacher
https://som.cuanschutz.edu/Profiles/Faculty/Profile/33013

Patient selection for TMS- Case report with Dr. Fenstermacher
https://journals.lww.com/hrpjournal/fulltext/2025/11000/case_report__personalizing_transcranial_magnetic.3.aspx

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There is a growing awareness in psychiatry that not all psychiatric illness is psychiatric— some percentage of what presents in psychiatric settings is actually triggered by autoimmune responses to various pathogens and insults.  In the late '90s a syndrome called PANDAS (pediatric autoimmune neuropsychiatric disorders associated with strep) came on the scene with cases of sudden onset OCD and tics that appeared in conjunction with strep infections. The theory behind PANDAS was that parts of the basal ganglia of the brain had exterior cell proteins which were very similar to those of the strep bacteria, and as the immune system began to attack the strep bacteria, it also began an autoimmune assault on parts of the midbrain, including the basal ganglia, thus producing a sudden onset of OCD or tics.

In recent years PANDAS has evolved into a broader concept called PANS— pediatric acute onset neuropsychiatric syndrome— which includes a vast array of neurological and psychiatric symptoms and syndromes that can potentially be triggered by autoimmune reactions. It can be tricky to diagnose PANS….this is probably why it is still a somewhat controversial diagnosis in some arenas. We don’t have a clear and consistent set of labs or biomarkers to positively determine PANS, and because the syndrome is so broad in how it can present, clinicians struggle to come up with a modal or average presentation that they can put in their pattern recognition systems. 

One feature that seems fairly classic for PANS is that the symptoms tend to increase during and/or right after a concomitant infectious illness, presumably because the immune system activation is reigniting the autoimmune attack on the central nervous system.

Today’s story features a mom, Kari, and her daughter, Zoe. Zoe had lots of illness and immune system issues as a young child, first fatigue and then GI symptoms, then profound mood instability, and then she eventually developed horrific treatment resistant anorexia which did not respond to the best treatments psychiatry had to offer.

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Explore the podcast through themes, domains, formats, and speakers.
The BFTA CODEX is a listener-built and curated field guide to every episode.
https://bfta-codex.org
"I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, June 18-20 2026 in Vancouver BC
https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/

BFTA episode recommendations/Podcast page
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