Back from the Abyss: Psychiatry in Stories

Craig Heacock MD
  • 4.9 (476)
  • MEDICINE
  • UPDATED SEMIMONTHLY

How do we find a way out of the darkest depths of despair? Psychiatrist Dr. Craig Heacock hosts a deep dive into powerfully moving stories of hope and healing, as well as topical explorations of psychopharmacology, psychotherapy, and psychedelics.

  1. 12/26/2025

    When psychiatric illness isn't just psychiatric-- The immune system, PANS, and psychiatric mimicry

    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. Support the show!  https://www.buzzsprout.com/396871/support Explore the full BFTA Content Catalog: A listener-built, human-curated index of every Back From The Abyss episode to help you find themes, topics, and episode formats of interest. Best viewed on a laptop or desktop (not mobile). Content Catalog (in Google Sheets): https://bftapod.short.gy/index "I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA  https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/ BFTA episode recommendations/Podcast page https://www.craigheacockmd.com/podcast-page/ Support the show

    1h 21m

  2. 12/12/2025

    10 Questions to Deepen Psychotherapy-- Inviting the Here and Now

    Psychotherapy can often get stuck in a there and then storytelling mode....how do we shift the therapeutic encounter into the immediacy of the Here and Now?  Here Dr. H shares 10 questions which shine a spotlight on what's happening (and not happening!) between therapist and patient.  Support the show!  https://www.buzzsprout.com/396871/support Explore the full BFTA Content Catalog: A listener-built, human-curated index of every Back From The Abyss episode to help you find themes, topics, and episode formats of interest. Best viewed on a laptop or desktop (not mobile). Content Catalog (in Google Sheets): https://bftapod.short.gy/index "I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA  https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/ BFTA episode recommendations/Podcast page https://www.craigheacockmd.com/podcast-page/ Support the show

    16 min

  3. 11/28/2025

    Is DID real? Parts, alters, exiles, and what's allowed in the therapeutic space

    Dr. H sits down with Jade Miller, a peer support specialist and advocate for public education about DID (Dissociative Identity Disorder). In the first part of this episode, Jade shares her story and how she came to understand that the puzzling gaps and often frightening incongruities in her life were caused by her rotating through a number of dissociated identities or alters, initially protecting her… but eventually leaving her powerless to stop repeated traumatization.  Jade and Dr. H then talk shop about DID and Jade challenges some of Dr. H's long held beliefs. Jade Miller https://payhip.com/peersupportformultiples Support the show!  https://www.buzzsprout.com/396871/support Explore the full BFTA Content Catalog: A listener-built, human-curated index of every Back From The Abyss episode to help you find themes, topics, and episode formats of interest. Best viewed on a laptop or desktop (not mobile). Content Catalog (in Google Sheets): https://bftapod.short.gy/index "I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA  https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/ BFTA episode recommendations/Podcast page https://www.craigheacockmd.com/podcast-page/ Support the show

    1h 8m

  4. 11/14/2025

    Parenting through the storm-- Adoption, trauma, acceptance, and humility

    BFTA storyteller Frank shares the joy, confusion, chaos, utter fear, and deepest gratitude when he and his partner Brad adopted and raised two boys, ages 4 and 2, from the foster care system. Twenty years ago, when Frank adopted the boys, trauma was not in the public awareness as it is today, and he was told that these little boys, who had spent some time in a meth house, might well have some challenges…..but he never could have expected what awaited. Can love overcome trauma? Can stability and structure and patience and compassion adequately compensate for profound early childhood neglect and abuse?  Frank’s story is just one example, but it’s a beautiful one, these two dads trying to find a way to heal deep attachment wounds without a roadmap.  Support the show!  https://www.buzzsprout.com/396871/support BFTA episode recommendations/Podcast page https://www.craigheacockmd.com/podcast-page/ Support the show

    1h 1m

  5. 10/31/2025

    When our minds forget our bodies remember-- A trauma therapist comes back to life

    Rachael, a trauma therapist and today's storyteller, describes how her early childhood abuse was buried by the protective mechanism of dissociative amnesia.  As Rachael wrote to Dr. H, “The only way I could continue to live, with no way out, with no one to tell, with no words even to describe what was happening to me, was to forget what was happening to me….when our minds forget, our bodies remember.” Rachael saved herself by forgetting, then was forced to finally face what happened to her when her body carried out its ultimate rebellion in the context of having her third child, her first girl….a little baby girl, with no one to protect her….or at least that’s what the terrible and unrelenting obsessions began to say. Support the show!  https://www.buzzsprout.com/396871/support Rachael Parsons Svendsen https://www.rachaelsvendsen.com/ Explore the full BFTA Content Catalog: A listener-built, human-curated index of every Back From The Abyss episode to help you find themes, topics, and episode formats of interest. Best viewed on a laptop or desktop (not mobile). Content Catalog (in Google Sheets): https://bftapod.short.gy/index "I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA  https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/ BFTA episode recommendations/Podcast page https://www.craigheacockmd.com/podcast-page/ Support the show

    1h 14m

  6. 10/17/2025

    Treatment-resistant bipolar disorder-- Finding stability at last

    This story is a mirror to Elizabeth’s story from season 1 episode 1. Today’s storyteller Sarah was so moved by Elizabeth’s story that it helped her to trust Dr. H's recommendation to take a pretty scary medication, the extremely powerful antipsychotic and mood stabilizer called clozapine.  So why tell this story again? As they say, history doesn’t repeat itself, but it does often rhyme, and Sarah’s story rhymes beautifully with Elizabeth’s. Both had severe and treatment resistant bipolar 1 disorder, formerly known as manic-depression. Both tried all the meds, did all the things, then eventually reached a point of utter hopelessness and despair….and then they had to trust Dr. H enough to try one more thing. Support the show!  https://www.buzzsprout.com/396871/support "I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA  https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/ BFTA episode recommendations/Podcast page https://www.craigheacockmd.com/podcast-page/ Support the show

    55 min

  7. 10/03/2025

    Hiding in plain sight-- Life, work, and therapy on the autistic spectrum

    In today’s story we explore what it’s like to be on the autistic spectrum, and more specifically, how a later life diagnosis can totally change the way you view the world and yourself. Aurelie, our storyteller today,  was an autism expert, a clinical psychologist who had trained with some of the premier autism experts in the country…yet she didn’t discover her own autism until she was 40 years old.  This episode explores why women on the spectrum are so often missed, how women on the autistic spectrum are so often masters of masking, which means imitating the mannerisms and behaviors of neurotypical people, thus allowing them to both fit in and also to be left hiding in plain sight.  Support the show!  https://www.buzzsprout.com/396871/support Dr. Aurelie Welterlin https://www.ncawag.net/our-team/dr-aurelie-welterlin "I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA  https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/ BFTA episode recommendations/Podcast page https://www.craigheacockmd.com/podcast-page/ Support the show

    1h 5m

  8. 09/19/2025

    Trapped in secrecy and shame-- A boy, his coach, and healing trauma with MDMA

    How do you rebuild trust amidst the ashes of trauma? This is the story of Sean, an up and coming star tennis player whose coach carefully selected him and then groomed him for years of sexual assault. His trust destroyed, Sean had to find a way to try to trust again…..and after many years of hiding and pretending and near self-destruction, Sean finally was able to share the details of what happened to him. Thus began his therapeutic journey of finding compassion for himself and trust toward others…with the guidance of his two devoted therapists and the assistance of MDMA. Support the show!  https://www.buzzsprout.com/396871/support "I Love You, I Hate You, Are You My Mom?"  An intensive experiential workshop exploring transference with Dr. H and Dr. Hillary McBride, Feb 4th-6th 2026 in Joshua Tree, CA  https://www.craigheacockmd.com/i-love-you-i-hate-you-are-you-my-mom/ BFTA episode recommendations/Podcast page https://www.craigheacockmd.com/podcast-page/ Support the show

    1h 36m
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4.9
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476 Ratings

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How do we find a way out of the darkest depths of despair? Psychiatrist Dr. Craig Heacock hosts a deep dive into powerfully moving stories of hope and healing, as well as topical explorations of psychopharmacology, psychotherapy, and psychedelics.

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