Docs Tracey and Paul Discuss It All!

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Psychiatry, Education, Insight. Docs Tracey and Paul Discuss it All! Two psychiatrists — Dr. Paul E. Keck Jr., MD and Dr. Tracey Goodman Skale, MD of TMBO (Two Minds, Better than One) — illuminate mental illness, teach signs and symptoms, dispel myths, and advocate timely care and dignity. Nearly 70 years of combined expertise. DISCLAIMER: educational/general discussion only, not personalized medical advice; in crisis call the 988 Suicide & Crisis Lifeline. 678441

Episodes

  1. 1d ago

    EP9 - Cluster B Personality Disorders: Histrionic, Antisocial, and Narcissistic Explained

    Cluster B personality disorders explained: Docs Tracey and Paul break down histrionic personality disorder, antisocial personality disorder, and narcissistic personality disorder. The episode answers how to tell personality traits from personality disorders, what histrionic, antisocial, and narcissistic presentations actually look like, and why shame, genetics, and brain function matter. In this episode: What makes a personality trait different from a personality disorder?What does histrionic personality disorder look like, and why is it more often diagnosed in women?How is antisocial personality disorder different from shyness, sociopathy, and psychopathy?What is splitting, and how can it show up in families or treatment teams?Why do people with narcissistic personality disorder need admiration, and what triggers narcissistic rage?How do projection and gaslighting work in narcissistic relationships?What happens to children raised by a narcissistic mother, and what helps them heal?Is Cluster B personality disorder treatable, and when should someone seek help?Hosts and links:Connect with Tracey Skale:Instagram: https://instagram.com/traceygskaleConnect with Paul Keck:Instagram: https://instagram.com/paul.keck.31Website: https://tmbodocs.com Resources mentioned:Will I Ever Be Good Enough? Healing the Daughters of Narcissistic Mothers by Dr. Karyl McBride, plus the companion workbookCrime and Human Nature by Wilson and HernsteinGaslight (the film that gave us the term gaslighting) Listen everywhere:Apple Podcasts: https://podcasts.apple.com/us/podcast/id6810333888Watch on YouTube: https://www.youtube.com/@TMBOdocs Helpful resources:Got a question for the show? Submit it here: https://www.tmbodocs.com/contactWant to listen to more episodes? Start here: https://www.tmbodocs.com/podcastNeed personalized help? Visit: https://www.tmbodocs.com Why subscribe? Docs Tracey and Paul make mental health conversations informative, thoughtful, approachable, and relevant for everyday people, families, mental-health professionals, and primary-care colleagues. Tracey brings frontline patient stories and energy. Paul translates the statistics, neuroscience, and research. Subscribe for plain-language explanations of psychiatric conditions, stigma-busting myth checks, and practical hope for getting help. What mental-health question would you like Docs Tracey and Paul to discuss next? Share it in the comments. If you or someone you love is in crisis, call or text 988 (988 Suicide & Crisis Lifeline) in the US. Cluster B personality disorders are treatable, and loved ones can break cycles with support. If this episode sounds like your family, reach out to a qualified clinician and start with one safe boundary. DISCLAIMER: This episode is for educational and general discussion only. It is not a substitute for personalized medical advice, diagnosis, or treatment. Consult your own qualified healthcare professional. If you are in crisis, call or text 988 (988 Suicide & Crisis Lifeline) in the US. DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances.If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances.If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. Chapters:00:00 Introduction01:37 Personality traits vs personality disorders02:47 Histrionic personality disorder explained09:22 Splitting, manipulation, and treatment teams11:26 Antisocial personality disorder vs sociopathy14:02 Conduct disorder, genetics, and the legal system22:45 Charming sociopathy, love bombing, and limerence31:01 Narcissistic personality disorder and shame40:31 Daughters of narcissistic mothers and healing47:15 Treatment, boundaries, and hope DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances.If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. Produced by Pod Bros Media: https://podbrosmedia.com (00:00) - Introduction (01:37) - Personality traits vs personality disorders (02:47) - Histrionic personality disorder explained (09:22) - Splitting, manipulation, and treatment teams (11:26) - Antisocial personality disorder vs sociopathy (14:02) - Conduct disorder, genetics, and the legal system (22:45) - Charming sociopathy, love bombing, and limerence (31:01) - Narcissistic personality disorder and shame (40:31) - Daughters of narcissistic mothers and healing (47:15) - Treatment, boundaries, and hope

    EP9 - Cluster B Personality Disorders: Histrionic, Antisocial, and Narcissistic Explained

  2. Oct 28

    EP8 - Cluster B Personality Disorders Explained: Borderline Symptoms and Treatment

    In this episode, Docs Tracey and Paul explain Cluster B personality disorders and take a close look at borderline personality disorder, from symptoms to treatment and real recovery. Borderline personality disorder is a treatable condition marked by unstable relationships, a shaky sense of self, rapid mood shifts, and impulsivity. The docs walk through the DSM-5-TR criteria in plain language, explain what is happening in the brain, and share why long-term outcomes are far better than most people expect. In this episode: - What is the difference between a personality and a personality disorder? - Which four conditions belong to Cluster B, and what do they share? - What are the core borderline personality symptoms, and why five of the nine criteria are needed for diagnosis? - What do idealization and devaluation look like in borderline personality disorder relationships? - How is borderline personality disorder different from bipolar disorder? - Why is borderline personality disorder diagnosed more often in women, and what does referral bias mean? - Which brain regions are involved, including the amygdala (the brain's alarm center) and the prefrontal cortex (the brain's brake and planning center)? - What is dialectical behavior therapy (DBT), and why is it the gold standard treatment? - Can people recover from borderline personality disorder? Resources mentioned: DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision) DBT skills worksheets and homework used in dialectical behavior therapy Radically Open DBT, a treatment approach for over-controlled presentations The Hateful Patient, the classic paper Dr. Tracey references when talking about countertransference Pete Davidson, who has spoken publicly about living with borderline personality disorder Listen everywhere: Apple Podcasts: https://podcasts.apple.com/us/podcast/id6810333888 Watch on YouTube: https://www.youtube.com/@TMBOdocs Helpful resources: Got a question for the show? Submit it here: https://www.tmbodocs.com/contact Want to listen to more episodes? Start here: https://www.tmbodocs.com/podcast Need personalized help? Visit: https://www.tmbodocs.com Why subscribe? Docs Tracey and Paul Discuss It All! is a warm, conversational show from two married psychiatrists with more than 70 years of combined experience. Dr. Tracey Skale brings frontline patient stories, energy, and enthusiasm. Dr. Paul Keck brings the statistics, neuroscience, and research. Every episode leads with hope and treatability, explains clinical terms in plain language the first time they appear, and pushes back on stigma, using only de-identified patient stories. The show is built for everyday people and families who are recognizing mental-health struggles in themselves or someone they love, and for mental-health professionals and primary-care colleagues who want practical, clinically precise conversation. New episodes help you understand conditions such as depression, bipolar disorder, schizophrenia, anxiety, OCD, and personality disorders, and what actually helps. What mental-health question would you like Docs Tracey and Paul to discuss next? Share it in the comments. If you or someone you love is in crisis, call or text 988 (988 Suicide & Crisis Lifeline) in the US. DISCLAIMER: This episode is for educational and general discussion only. It is not a substitute for personalized medical advice, diagnosis, or treatment. Please consult your own qualified healthcare professional about your individual situation. If you or someone you love is in crisis, call or text the 988 Suicide & Crisis Lifeline in the US. Chapters: 00:00 Introduction 01:00 What personality is and when traits become a personality disorder 05:30 Cluster B personality disorders and the history of the word borderline 09:30 Stigma, pain, and walking through the DSM-5-TR criteria with patients 13:20 Fear of abandonment, idealization, and devaluation 17:30 Impulsivity and self-harm, and how borderline differs from bipolar disorder 27:50 Risk factors: genetics, childhood adversity, and referral bias 34:00 Brain science, plus under-controlled vs over-controlled borderline 41:40 Treatment: DBT, good psychiatric management, MBT, CBT, schema therapy 45:00 Remission, recovery, and hope DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances. If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. Produced, Edited, and Distributed by @PodBrosMedia https://podbrosmedia.com (00:00) - Introduction (01:00) - What personality is and when traits become a personality disorder (05:30) - Cluster B personality disorders and the history of the word borderline (09:30) - Stigma, pain, and walking through the DSM-5-TR criteria with patients (13:20) - Fear of abandonment, idealization, and devaluation (17:30) - Impulsivity and self-harm, and how borderline differs from bipolar disorder (27:50) - Risk factors: genetics, childhood adversity, and referral bias (34:00) - Brain science, plus under-controlled vs over-controlled borderline (41:40) - Treatment: DBT, good psychiatric management, MBT, CBT, schema therapy (45:00) - Remission, recovery, and hope

    EP8 - Cluster B Personality Disorders Explained: Borderline Symptoms and Treatment

  3. Oct 21

    EP7 - OCD and Related Disorders DSM 5: Symptoms in Adults, OCD vs Anxiety

    OCD and related disorders DSM 5 explained in plain language: Docs Tracey and Paul cover OCD in adults, OCD vs anxiety, and the symptoms families often miss. The episode answers what obsessive compulsive and related disorders are, how obsessions and compulsions differ from everyday worry, and which conditions sit together in DSM-5-TR, the diagnostic manual clinicians use. In this episode: - What are obsessions and compulsions, and when do they become OCD? - How common is OCD, what is the average age of onset, and when should families suspect it? - How is OCD different from anxiety, depression, and obsessive compulsive personality disorder (OCPD)? - Which conditions are included in obsessive compulsive and related disorders? - What are common OCD symptoms in adults, including contamination fears, checking, counting, and intrusive thoughts? - What is body dysmorphic disorder, and how does muscle dysmorphia fit? - What do hoarding disorder, trichotillomania (compulsive hair pulling), and excoriation disorder (compulsive skin picking) look like? - What is the gold standard treatment for OCD, including exposure and response prevention (ERP), selective serotonin reuptake inhibitors (SSRIs), transcranial magnetic stimulation (TMS), and deep brain stimulation? Resources mentioned: the OCD Foundation website, described as a good resource for people across the country, and Charlie Brady, PhD, named as an OCD expert. Listen everywhere: Apple Podcasts: https://podcasts.apple.com/us/podcast/id6810333888 Watch on YouTube: https://www.youtube.com/@TMBOdocs Helpful resources: Got a question for the show? Submit it here: https://www.tmbodocs.com/contact Want to listen to more episodes? Start here: https://www.tmbodocs.com/podcast Need personalized help? Visit: https://www.tmbodocs.com Why subscribe? If you are an everyday person or family member trying to recognize mental-health struggles in yourself or someone you love, this show gives you warm, clinically precise language without shame or jargon. Mental-health professionals and primary-care colleagues will also find practical explanations of DSM-5-TR categories, symptoms, and treatments. Docs Tracey Skale and Paul Keck bring 70+ years combined experience, frontline patient stories, neuroscience, and a married-couple rhythm that makes hard topics approachable. The goal is simple: make mental health conversations informative, thoughtful, approachable, and relevant while leading with hope and treatability. What mental-health question would you like Docs Tracey and Paul to discuss next? Share it in the comments. If you or someone you love is in crisis, call or text 988 (988 Suicide & Crisis Lifeline) in the US. Disclaimer: This episode is for educational and general discussion only. It is not a substitute for personalized medical advice, diagnosis, or treatment. Consult your own qualified healthcare professional. If you or someone you love is in crisis, call or text 988 (988 Suicide & Crisis Lifeline) in the US. DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances. If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. Chapters: 00:00 Introduction 01:14 How OCD moved out of anxiety disorders in DSM-5-TR 02:31 Obsessions, compulsions, and how OCD is diagnosed 06:39 Common OCD symptoms, shame, and contamination fears 08:14 Insight, catatonia look-alikes, and comorbid conditions 12:28 Brain areas, PANDAS, and risk factors 19:52 OCD vs normal childhood rituals and common compulsions 25:43 Body dysmorphic disorder, hoarding, trichotillomania, and skin picking 44:36 OCD vs anxiety, depression, and OCPD 49:17 Treatment: ERP, SSRIs, TMS, and hope DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances. If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline.Produced by Pod Bros Media: https://podbrosmedia.com (00:00) - Introduction (01:14) - How OCD moved out of anxiety disorders in DSM-5-TR (02:31) - Obsessions, compulsions, and how OCD is diagnosed (06:39) - Common OCD symptoms, shame, and contamination fears (08:14) - Insight, catatonia look-alikes, and comorbid conditions (12:28) - Brain areas, PANDAS, and risk factors (19:52) - OCD vs normal childhood rituals and common compulsions (25:43) - Body dysmorphic disorder, hoarding, trichotillomania, and skin picking (44:36) - OCD vs anxiety, depression, and OCPD (49:17) - Treatment: ERP, SSRIs, TMS, and hope

    EP7 - OCD and Related Disorders DSM 5: Symptoms in Adults, OCD vs Anxiety

  4. Oct 14

    EPISODE #6: Anxiety – When Worry Takes Over Your Life

    In this episode, Docs Tracey and Paul explain that anxiety disorders are common, can become disabling, but are still treatable. They explain the main types of anxiety: generalized anxiety, social anxiety, specific phobias, panic disorder, and agoraphobia, and discuss the different regions of the brain that are involved. In addition to describing key symptoms and physical effects, Tracey and Paul present practical interventions such as diaphragmatic breathing, grounding techniques, cognitive behavioral therapy, lifestyle changes, and medications including SSRIs, SNRIs, and limited benzodiazepine use. The docs also emphasize that many people improve with treatment and encourage listeners to seek help and support from loved ones. *DISCLAIMER* This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances. If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. Produced by Pod Bros Media: https://podbrosmedia.com

  5. Oct 7

    EPISODE #5: Anosognosia and the LEAP approach with Dr. Xavier Amador

    In this episode, Dr. Xavier Amador, founder of the LEAP Institute and originator of the LEAP® method, joins Docs Tracey and Paul to discuss anosognosia as a bona fide neurological symptom rather than a moral failing or simple denial. They describe the term's origin in early neurology and how contemporary research in schizophrenia and bipolar disorder shows consistent findings: executive dysfunction, frontal lobe impairment, and structural differences in the prefrontal cortex. When a person with a severe and persistent mental illness persistently asserts they are not ill for months, that assertion typically reflects a brain-based deficit in self-appraisal. We also address the ethical and practical dilemmas of involuntary treatment. We acknowledge deep respect for individual rights while defending court-ordered outpatient treatment and carefully considered inpatient holds when judgment is impaired by brain disorder. We draw on lived experience and clinical cases where timely involuntary intervention prevented harm and later elicited gratitude. Training clinicians, law enforcement, judges, and families in LEAP principles is presented as a concrete means to reduce coercion and improve outcomes while preserving dignity. Learn more about the LEAP Institute at leapinstitute.org. *DISCLAIMER:* This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances. If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. Produced by Pod Bros Media: https://podbrosmedia.com

  6. Sep 30

    Episode #4: Schizophrenia – Truth, Myths, and Hope

    In this episode, Docs Tracey and Paul present schizophrenia as a serious mental illness that is defined primarily by psychosis, including hallucinations and delusions. Having treated thousands of patients with schizophrenia, Tracey notes that onset is often in the late teens or early twenties and that both genetic and environmental factors contribute to risk.  When it comes to treating schizophrenia, antipsychotic medications can reduce positive symptoms, but have side effects – and there are limited pharmacologic options for negative and cognitive symptoms, so psychosocial supports and community care are essential. Tracey and Paul describe catatonia and command hallucinations and stress the importance of early intervention to protect brain function.  So-called "wraparound" services are essential, including case management, vocational and peer support, and family education. Tracey and Paul urge compassion and continued research and affirm that with timely, comprehensive care many people can improve significantly.  DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances. If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. Produced by Pod Bros Media: https://podbrosmedia.com

  7. Sep 23

    EPISODE #3: Is It Bipolar, or Just a Mood Swing?

    In this episode, Docs Tracey and Paul speak as clinicians and internationally regarded experts in treating bipolar disorder. They define the clinical poles of mania and depression and emphasize that many patients experience mixed states that combine elements of both. They review key diagnostic signs that help distinguish bipolar from unipolar depression: early onset in childhood, psychotic features in depression, postpartum psychosis, abrupt "light switch" changes in mood, poor or paradoxical response to antidepressants, and family history. Tracey and Paul stress that "mania" is diagnosed by duration and change from baseline and that "hypomania" is subtler, but clinically important. They recommend a careful, structured history and collateral information from family or friends. Tracey explains the DIG-FAST mnemonic for mania to guide clinicians and families. They underscore the importance of sleep and circadian stability as triggers for mood shifts. The central message is that accurate diagnosis matters because the treatments and risks differ substantially between bipolar I, bipolar II, and unipolar depression. DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances. If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. Produced by Pod Bros Media: https://podbrosmedia.com

  8. Sep 16

    EPISODE #2: DEPRESSION — Am I Depressed or Just Having a Bad Week?

    In the second episode of Docs Tracey and Paul Discuss it All, we define major depressive disorder with clinical precision. We distinguish transient sadness from pathological depression by highlighting loss of interest, functional decline, disrupted sleep and appetite, reduced energy, impaired concentration, and the presence of suicidal ideation. We emphasize that many patients report emotional numbness rather than recognizable sadness, and discuss vegetative signs tied to the limbic system, noting that suicidal thinking can range from passive thoughts to concrete plans. We underscore the need for objective tracking with rating scales and for clinicians to ask directly and calmly about suicide. We assert that the treatment aim is full remission, not mere reduction of symptoms, and that shared decision making and long term maintenance of effective therapies are essential. DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances. If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. Produced by Pod Bros Media: https://podbrosmedia.com

  9. Sep 9

    EPISODE #1: Two Minds, Better Than One – Docs Tracey and Paul Discuss it All!

    When it comes to mental health, Docs Tracey and Paul Discuss it All! This episode centers on the intricate and multifaceted nature of mental illness, as discussed by esteemed psychiatrists, Dr. Tracey Skale and Dr. Paul Keck. In this inaugural installment of a series dedicated to mental health, we endeavor to elucidate the definition of mental illness and explore its prevalence and impact on individuals and society at large. Our collective experience of over 70 years in the psychiatric field equips us with unique experience and insights, which we hope to share with both the general public and our professional peers. Throughout the series, we will examine various mental health conditions, including depression, bipolar disorder, schizophrenia, and anxiety disorders –while fostering a deeper understanding of these critical issues. Through our new podcast – Docs Tracey and Paul Discuss it All – we aspire to provide a platform for open dialogue, reducing stigma and enhancing awareness regarding the complexities of mental health. DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances. If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. Produced by Pod Bros Media: https://podbrosmedia.com

  10. Season 1 Trailer

    Two Minds, Better Than One – Docs Tracey & Paul Discuss It All

    Welcome to Tracey & Paul Discuss It All! Psychiatric illness is unequivocally the foremost public health challenge confronting our society today. In this discourse, Docs Tracey and Paul (Dr. Paul E. Keck Jr., MD and Dr. Tracey Goodman Skale, MD) endeavor to illuminate the pervasive nature of mental health issues, and create public awareness and understanding of the signs and symptoms associated with various psychiatric disorders. The goal of our podcast is to empower every day people – and mental health professionals – to recognize potential mental health struggles in themselves and those around them, and helping to facilitate timely access to appropriate care. In each episode, we'll explore the complexities of mental illness and dispel prevalent myths that cloud public perception. With nearly 70 years of combined expertise in psychiatry, Docs Tracey and Paul are dedicated to fostering a compassionate dialogue surrounding mental health, ultimately advocating for the dignity and respect of those affected by mental illness. DISCLAIMER: This podcast discusses mental health topics that may be sensitive or triggering for some listeners. The information shared is for educational and general discussion purposes only and is not a substitute for personalized medical advice, diagnosis or treatment. Please consult your own qualified healthcare professional for guidance tailored to your unique needs and circumstances. If you are in crisis, reach out to a local mental health provider or call the 988 Suicide & Crisis Lifeline. Produced by Pod Bros Media: https://podbrosmedia.com

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Psychiatry, Education, Insight. Docs Tracey and Paul Discuss it All! Two psychiatrists — Dr. Paul E. Keck Jr., MD and Dr. Tracey Goodman Skale, MD of TMBO (Two Minds, Better than One) — illuminate mental illness, teach signs and symptoms, dispel myths, and advocate timely care and dignity. Nearly 70 years of combined expertise. DISCLAIMER: educational/general discussion only, not personalized medical advice; in crisis call the 988 Suicide & Crisis Lifeline. 678441

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