Why People Die By Suicide: Theories Through History
While in psychiatry we avoid using declarative or certain language about mechanisms, it can be helpful to think about the narratives that drive people to behavior that will ultimately end their life. In this episode Margaret and I review the Durkheim principles of suicidality following the four categories: anomic, fatalistic, egoistic and altruistic. We talk about how each has a distinct flavor in the clinical setting and which ones are better handled by safety planning or solution based interventions.
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Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.
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Watch on YouTube: @itspresro
Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.
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Produced by Dr and Lady Glaucomflecken & Human Content
Get in Touch: howtobepatientpod.com
Learn more about your ad choices. Visit megaphone.fm/adchoices
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1:12:50
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1:12:50
Eating Disorders for Psychiatrists: Part 2
It’s Part 2 of our deep dive into eating disorders—and this time, we’re going even deeper. We kick off by unpacking our mock therapy session with Dr. Helen Liljenwall, which unexpectedly hit close to home for all of us. Then we take a sharp turn into the medical realities of starvation, including refeeding syndrome, the female athlete triad, and why your heart is always in the equation (literally).
But what happens when patients refuse to eat—and we have to decide whether they need a psychiatric hold? Who gets to say when a person with an eating disorder has lost capacity? And is “terminal anorexia” a compassionate truth—or a dangerous excuse?
If you’ve ever wondered what it really takes to treat eating disorders, this is the episode to hear. It's raw, real, and it doesn’t flinch.
Takeaways:
Refeeding syndrome isn’t just a med school concept—it’s a real, life-threatening danger in eating disorder treatment.
Psychiatric holds for anorexia raise tough ethical questions about autonomy, capacity, and what it means to save a life.
That fake therapy session? It’s not so fake when the emotional stakes are this high.
The eating disorder voice can sound like discipline—but it’s often masking deep distress.
Terminal anorexia is a controversial idea… and we don’t shy away from the controversy.
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Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.
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Watch on YouTube: @itspresro
Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.
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Produced by Dr Glaucomflecken & Human Content
Get in Touch: howtobepatientpod.com
Learn more about your ad choices. Visit megaphone.fm/adchoices
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52:36
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52:36
Eating Disorders for Psychiatrists: Part 1
This is Part 1 of our two-part deep dive into eating disorders—and we’re starting at the beginning. Margaret and I sit down with psychiatrist and eating disorder specialist Helen Liljenwall, MD to walk through the basics: What are the major types of eating disorders? What do they actually look like in real life? And how do we treat something that’s rooted in both biology and culture? We cover everything med school skipped—then try to practice what we’ve learned in a fake (but emotionally real) therapy session with Dr. Helen as the patient. Spoiler: it got uncomfortable in all the right ways.
Takeaways:
Eating disorders don’t come with a single look—or a single diagnosis. We break down the ones you’ve heard of and the ones you haven’t.
Every med student should hear this conversation. Because we weren’t taught how to spot this stuff—let alone treat it.
Practicing therapy with an expert in the “patient” seat is more terrifying than it sounds.
This isn’t just about food. It’s about fear, shame, and survival strategies.
We’re not pretending to know everything. We’re starting with the basics—so we can learn to do better.
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Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.
--
Watch on YouTube: @itspresro
Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.
—
Produced by Dr Glaucomflecken & Human Content
Get in Touch: howtobepatientpod.com
Learn more about your ad choices. Visit megaphone.fm/adchoices
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59:18
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59:18
The History and Process of Psychiatric Detainment
Margaret and I talk about what it feels like to care for patients who remind us a little too much of ourselves, especially when we’re also the ones filling out the paperwork for a psychiatric hold. We dig into what a 5150 (or 5585) really means, how to sit with that kind of authority, and the emotional mess of seeing a patient’s fear reflect your own.
Psychiatric holds carry legal weight, but emotional weight, too. We talk about what it’s like to sit with both.
Takeaways:
Signing a psych hold form never feels casual—especially when the patient could’ve been me.
Overidentifying isn’t compassion—it’s a signal that I might need supervision, fast.
Letting go of a patient isn’t always a failure. Sometimes it’s a kindness.
Psychiatric holds carry legal weight, but emotional weight, too. We talk about what it’s like to sit with both.
Empathy is powerful—until it gets in the way. Learning where to stop is part of learning how to stay.
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Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.
--
Watch on YouTube: @itspresro
Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.
—
Produced by Dr Glaucomflecken & Human Content
Get in Touch: howtobepatientpod.com
Learn more about your ad choices. Visit megaphone.fm/adchoices
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1:14:41
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1:14:41
The History of Burnout (And Our Maslach Scores)
In this episode, Margaret and I take on burnout—what it actually is, where the term came from, and how to tell when you’re not just tired, but something deeper is cracking. We dig into the history, the Maslach Inventory, moral injury, and why burnout isn’t in the DSM (yet). We also share our own unhinged burnout moments (yes, mine involves harmonica) and explore how to tell the difference between burnout, depression, and just being in the wrong place.
Reference: MBI Self Test: https://drive.google.com/file/d/16OJpRvvrGfs8SEEXgKk_Em8NgZerZkdo/view
Takeaways:
Did I buy a harmonica during a burnout spiral? Yes. Was it helpful? Also yes.
Burnout isn’t just a vibe—it has a whole inventory. We took it, and let’s just say… some of us are more charred than others.
Moral injury hits different when you’re the one holding the clipboard. Especially when someone else made the call.
Burnout and depression aren’t the same—but they like to hang out. And sometimes you don’t know which one’s driving.
Not all coping strategies are cute. Some look like spreadsheets. Some look like chili’s. Some look like crying in a hospital bathroom.
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Ready to take your exam prep to the next level? Go to http://www.NowYouKnowPsych.com and enter the code BEPATIENT at checkout for 20% off.
--
Watch on YouTube: @itspresro
Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.
—
Produced by Dr Glaucomflecken & Human Content
Get in Touch: howtobepatientpod.com
Learn more about your ad choices. Visit megaphone.fm/adchoices
You may have noticed a new trend lately. Everyone is loud and proud about their mental health struggles (and thank goodness)! For practitioners, this movement is as exciting as it is frustrating. As each mental health taboo falls by the wayside as it enters the cultural zeitgeist, a new aspect of our specialty thus emerges. One we just don’t have enough hours in the day to keep track of, let alone engage with. From better understanding our patients’ (and our own) relationships with their conditions in a changing world, it’s more important than ever that we learn: HOW TO BE PATIENT!
Each week, join Dr. Preston Roche (Psychiatry Resident & Digital Influencer) and Dr. Margaret Duncan (Psychiatrist & Content Creator) on their quest to better understand the patients we dedicate our lives to and the evolving paths they’re bound to travel beyond the clinic. By engaging with stories and perspectives that challenge our shared understanding of a condition, we hope you’ll similarly gain new perspectives as we look at our patients, and their mental health struggles, with further nuance and empathy. (And with Dr. & Lady Glaucomflecken producing, we've been mandated to include plenty of weird medical jokes too).
Speaking of which, a key part of this is hearing YOUR stories! What’s changed your understanding of patient care? Do you have an experience that shines new light on something we’ve discussed on-air? Get in touch at: howtobepatientpod.com
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