Psyched Perspectives

Psyched Perspectives

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Mental Health

Psyched Perspectives is a series in which host Frank A. Clark, MD, converses with his colleagues about the practice of psychiatry, targeting its many controversial topics.

Sep 23

The Bidirectional Relationship Between Mental Health and Cardiovascular Disease With Mary Branch, MD

In this episode of “Psyched Perspectives,” host Frank A. Clark, MD, speaks with Mary Branch, MD, a noninvasive cardiologist with subspecialty training in cardio-oncology, about the bidirectional relationship between cardiovascular disease and mental health. Branch, who trained at Case Western, Massachusetts General, UNC, and Wake Forest, built a cardio-oncology program at Cone Health in Greensboro, North Carolina, before relocating to practice in an underserved region of western Kentucky. The conversation centers on how closely cardiovascular and psychiatric health are intertwined. Branch cites a study by Senoo et al in the Journal of the American College of Cardiology: Asia linking depression to subsequent cardiovascular disease, noting the association is particularly pronounced in women. She points out that fewer than 20% of patients with cardiovascular disease receive adequate treatment for co-occurring depressive symptoms, attributing the gap partly to patients misattributing anxiety-driven symptoms (such as palpitations) to cardiac causes, and partly to persistent stigma around mental illness. She also flags iatrogenic contributors, including cardiac and antipsychotic medications, and the role of social determinants of health. On nutrition and food insecurity, Branch describes a gradual, culturally sensitive counseling approach rather than prescribing wholesale dietary overhauls: encouraging patients to halve portions, make small ingredient swaps (such as grilled or baked proteins in place of fried), and focus on a handful of meals they already enjoy, tweaked to be somewhat healthier. Branch also discusses her path into cardio-oncology, sparked during internal medicine training when she found meaning in goals-of-care conversations with cancer patients. She describes the substantial mental health burden faced by patients managing both cancer and cardiovascular risk, particularly among breast cancer patients, and credits mentorship from women leaders in the still-emerging field. Asked about alcohol, Branch notes that current hypertension guidelines lean toward abstention given cardiovascular risk, but frames occasional, moderate consumption as lower-risk than daily habitual drinking, which she suggests may signal an unaddressed mental health need. Both clinicians advocate for closer collaboration between cardiology and psychiatry, including cross-referral relationships and joint educational events, to help identify patients whose symptoms may be psychiatric rather than cardiac in origin, and vice versa. Branch praises psychiatric colleagues' attentiveness to QTc-prolongation risk when prescribing psychotropic medications alongside cardiac care, and says the field's main need is greater psychiatric workforce capacity rather than any gap in current collaboration. The episode closes with Branch reflecting on her legacy: a physician devoted to service, integrity, and building bridges across medical, racial, and societal lines, as a fourth-generation physician aiming to mentor others navigating similar paths.
Sep 16

Grief's Impact on Public Health and Policy With Joyal Mulheron, MSc, and Lauren Rowley, MBA, RN

In this episode of “Psyched Perspectives,” host Frank A. Clark, MD, discusses bereavement with Joyal Mulheron, MSc, and Lauren Rowley, MBA, RN, of Evermore, an organization focused on bereavement policy, research, and support. Mulheron founded Evermore after her daughter's death and years advising policymakers on public health issues; Rowley, a registered nurse, joined Evermore's board after losing her brother Jeffrey to COVID-19 in March 2020. Both guests describe what draws them to this work: Rowley's personal loss transformed her clinical experience at patients' bedsides into a deeper calling to support the bereaved, while Mulheron recounts how a string of national tragedies (Sandy Hook, the death of Trayvon Martin, and others) convinced her that existing support systems—support groups and hard-to-access therapy—were inadequate, prompting her to leave her job and begin listening to grieving people directly. The conversation centers heavily on health disparities in bereavement. Mulheron explains that the US does not track bereavement statistics directly, so mortality data serves as a proxy, revealing uneven impacts across populations. She cites the COVID-19 "multiplier effect" (each death directly affecting 8 to 9 people), and notes that bereavement carries serious downstream health consequences beyond sadness—including cardiac events, immune dysfunction, and increased mortality risk, particularly among bereaved children, siblings, parents, and spouses. She highlights that 80% to 90% of incarcerated youth experienced a death event shortly before incarceration, and that over half of American orphans are not receiving Social Security survivor benefits owed to them, disproportionately affecting boys of color. Riley adds that Black siblings face significantly higher likelihood of losing a sibling by age 10 and 60 compared with White siblings. The guests describe policy wins, including paid bereavement leave for US armed forces members, the Social Security Board's first formal acknowledgment of orphanhood as an issue, and authoring the federal government's first fatality response guide for child deaths. Mulheron notes a review of roughly 14,000 studies on bereavement interventions found only 200 met rigorous evidence standards, underscoring the field's need for better research. Mulheron also pushes back on "resilience" framing, preferring the concept of "weathering"—how much loss a person can absorb—and emphasizes that grief is not something to "heal" from but something woven into identity. The episode closes with reflections on shared humanity, connection across difference, and a call to check on neighbors, particularly those different from oneself.
Sep 2

What Public Health Can Teach Us About Culturally Affirming Care With Shambrekia Wise

In this episode of “Psyched Perspectives,” host Frank A. Clark, MD, sits down with Shambrekia Wise, who is an author, entrepreneur, and public health professional, to discuss the Sightseeing Sandy Project. This is a children's book series she created with her daughter, Sandy, to introduce young readers to world cultures without the financial barriers that often limit family travel. Wise, a Gates Millennium Scholar with a background in public health, said that training shaped both her professional outlook and the values behind the series. She described public health work as having removed unconscious biases and given her a foundation for engaging people across different backgrounds with respect and openness—values she said translate directly into the books, which center on cultural humility rather than adopting or judging the practices of other cultures. The project began after a family trip to Los Angeles, prompted by a round-table invitation Wise received following her 2015 multiple sclerosis diagnosis. During the trip, Sandy, then a young child, noticed few children on her flight who looked like her and asked her mother why. That conversation, about financial, time, and health barriers that can limit travel access for some families, led Sandy to propose solutions of her own, eventually settling on the idea of a book series after a market-research trip to a Dallas bookstore in 2020 turned up nothing similar on the shelves. The series has since published 6 titles covering the Bahamas, Paris, Jamaica, India, North Africa, and Chicago, with characters and story details drawn from real cultural touchpoints, historical figures, and family research. Asked why mental health clinicians in particular might take an interest in the series, Wise pointed to representation as a bridge-building tool in clinical settings. She said that when young patients see characters they can identify with, it can open communication and help close gaps in understanding between clinicians and patients from different cultural backgrounds—paralleling the same intentionality she applies with her own daughter to build trust and connection. "I feel like that same care and concern can basically be in that situation too with your health care providers when they have adolescents and younger children that they're treating," Wise said. Wise also discussed an upcoming expansion of the project: a 100-path travel-themed board game for 2 to 6 players, developed with more than 200 trivia and activity cards spanning geography, culinary traditions, history, and landmarks featured across the book series. The first production run of 1500 units, manufactured overseas, is expected to arrive in early January and will include Black History Month-themed content timed to the game's release. The game will be sold through the company's own channels as well as Amazon and Shopify. Wise said the project remains a collaborative effort with her daughter, who has been involved in every book and the game's development from the outset, and that future titles are planned to expand representation further.
Aug 26

Vulernability as a Tool to Strengthen the Therapeutic Alliance With Manizeh Mirza-Gruber, MD

In this episode of “Psyched Perspectives,” host Frank A. Clark, MD, sits down with Manizeh Mirza-Gruber, MD, a board-certified psychiatrist and certified mindfulness and mind–body medicine practitioner. Together, they discuss the role of vulnerability, presence, and collective awareness in contemporary psychiatric practice. Mirza-Gruber emphasized that vulnerability, both as clinicians and as human beings, requires allowing internal experiences to arise without judgment and acknowledging their legitimacy. She characterized vulnerability not as weakness but as a source of authentic connection that strengthens the therapeutic alliance and fosters psychological safety. With personal experience and clinical examples, Mirza-Gruber illustrated how simple acts of shared presence, such as pausing and breathing with a patient, can open space for emotional release and deepen trust. She highlights that clinicians often default to action and productivity at the expense of presence. Reaffirming principles of interdependence, she noted that healing is best facilitated when clinicians and patients recognize their shared humanity. This includes cultivating practices that support collective awareness, rather than isolating emotional experiences within individuals. For trainees and early-career clinicians, Mirza-Gruber underscored the importance of integrating mindfulness, compassion, and embodied awareness into medical training. She argued that current models of care often neglect these dimensions, leading to fragmentation, burnout, and diminished continuity. To improve care delivery, she hoped for systems that normalize emotional expression, prioritize relational connection, and incorporate mind–body skills across disciplines.
Aug 20

Integrative Approaches to Chronic Pain With Julia Rodes, MD

In this episode of “Psyched Perspectives,” host Frank A. Clark, MD, chats with Julia Rodes, MD, a fourth-year psychiatry resident at the Medical University of South Carolina, about an integrative approach to chronic pain. Rodes researches brain stimulation interventions and gender differences in pain, and speaks from both a clinical and personal vantage point as a paraplegic following a spinal cord injury. Rodes explains that she became drawn to pain research after recognizing how much of psychiatry's caseload involves comanaging chronic pain, and how closely the neural pathways of pain overlap with those of depression and anxiety. She critiques the Western medical tendency to treat pain as something to eliminate before life can resume, arguing this mindset fuels an unending search for a pain-free state and contributed to the opioid epidemic. Drawing on the biopsychosocial model, she describes pain as a combination of physical sensation, affective response (such as catastrophizing), and learned behavior shaped by caregivers and social context—which helps explain why the same objective condition can produce wildly different subjective pain scores. A central moment in the conversation is Rodes reading a poem, "It Hurts to Be Awake" by Nina Roska, describing the relentless, inescapable nature of chronic pain. Both hosts reflect on its emotional weight, and Rodes connects it to her own experience: after her spinal cord injury changed and she regained sensation as pain, she developed a three-part approach combining a spinal stimulator, acceptance and commitment therapy—which she argues is emerging as a gold standard over cognitive behavioral therapy for pain—and reclaiming a sense of personal strength through activities like kayaking despite pain. Rodes also discusses using her visible disability as a clinical asset, noting that patients often feel an immediate sense of being understood or "on the same level" with her. She emphasizes that roughly 20% of Americans live with chronic pain, and up to 75% of those also have comorbid anxiety or depression. Her advocacy message to clinicians: help patients feel heard, and reframe treatment goals around functionality and quality of life rather than chasing a specific pain score. Looking ahead, she highlights transcranial magnetic stimulation as a promising nonpharmacological treatment being studied for fibromyalgia at MUSC. The episode closes with Rodes sharing that she'll soon join the VA system to care for veterans as she completes residency.
Aug 5

Navigating Trauma, Transformations, and Truth With Emily Lafferman, MD

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.
Jul 29

Exploring the Intersection of Sex and Psychiatry With Brittany Albright, MD, MPH

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.
Jul 22

The Cost of Capable: Race, Resilience, and the Hidden Weight of High Achievement

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.
Jul 15

Finding Joy and Balance in Busy Lives as Mental Health Practitioners

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.
Jul 8

Discussing Parental Leave With Patients

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.

10 Episodes

Psyched Perspectives is a series in which host Frank A. Clark, MD, converses with his colleagues about the practice of psychiatry, targeting its many controversial topics.

Creator

Psyched Perspectives
Years Active

2026
Episodes

10
Rating

Explicit
Show Website

Psyched Perspectives