This week, Margaret and I sat down with Dr. Jhilam Biswas, psychiatrist and expert on the intersection of law and mental health, for one of the hardest—and most important conversations we’ve had on the show. Together, we take a close look at how our justice system responds to mental illness: what happens when people in crisis are incarcerated instead of cared for, and how the prison system has become a stand-in for mental health treatment in the U.S.
Dr. Biswas helps us unpack the reality of solitary confinement, forced treatment, and the impossible choices clinicians face when caring for patients inside a system built for punishment, not healing. Alongside Margaret, I reflect on the human cost—on families, on providers, and on the people trapped in cycles of crisis and incarceration.
This isn’t just a policy issue—it’s a deeply personal one. And it’s urgent.
Takeaways:
The prison system has become the de facto mental health provider—and it’s failing people in crisis.
Solitary confinement and punishment often substitute for care, especially when individuals are suicidal.
Clinicians face impossible ethical dilemmas, forced to provide care within systems that perpetuate harm.
Alternatives to incarceration exist, but remain underfunded and underutilized.
Reimagining justice requires reimagining care—building systems that prioritize treatment, not punishment.
Citations:
Biswas J, Drogin EY, Gutheil TG. Treatment Delayed is Treatment Denied. J Am Acad Psychiatry Law. 2018 Dec;46(4):447-453. doi: 10.29158/JAAPL.003786-18. PMID: 30593474.
Biswas J. Dignity restored: the power of treatment first. CNS Spectr. 2024 Dec 23;30(1):e11. doi: 10.1017/S109285292400052X. PMID: 39714025.
Advocacy:
https://www.psychiatry-mps.org/
Jhilam Biswas:
Dr. Biswas Website:
https://psychexpertise.com/
https://www.neuroethicscollege.org/
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Listen Anywhere You Podcast: Apple, Spotify, PodChaser, etc.
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Produced by Dr Glaucomflecken & Human Content
Get in Touch: howtobepatientpod.com
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1:20:39
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1:20:39
Let’s Talk About Aphasias
What is aphasia, really and what happens when your brain no longer cooperates with your ability to speak or understand language? In this episode, Preston and Margaret tackle the messy, frustrating, and often isolating world of language disorders, focusing on the real-life implications of aphasia.
They walk through the clinical causes, what it looks like day-to-day, and how aphasia differs from other speech and cognitive issues. Along the way, they share stories of miscommunication, explore the frustrations of being misunderstood, and dig into how patients and clinicians can better work together when words are hard to find.
Takeaways:
Aphasia isn’t about intelligence—it’s about access.
There’s more than one kind of aphasia—and none of them are simple.
Communication breakdowns aren’t just frustrating—they’re isolating.
Not all “word-finding problems” are created equal..
Listening might be the most important clinical skill we overlook.
Citations:
Main paper discussed during episode: https://pmc.ncbi.nlm.nih.gov/articles/PMC2854959/pdf/jcn-2-149.pdf
Aphasia and the Diagram Makers Revisited: an Update of Information Processing Models Kenneth M. Heilman, M.D. The James E. Rooks Jr. Distinguished Professor, Department of Neurology, University of Florida College of Medicine, and VAMC, Gainesville, Florida
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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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53:08
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53:08
Is My Pain All In My Head?
Is it all in your head or is pain more complex than we’ve been led to believe? In this episode, Margaret and I dig into the psychological and biological factors that shape our experience of pain, including how the brain processes physical discomfort, the emotional toll it takes, and what role medications actually play. We also share stories from our own lives and clinical work that highlight how pain shows up in complicated, often misunderstood ways. If you've ever wondered why your body hurts when your heart is breaking, or why painkillers don’t always work, this one’s for you.
Takeaways:
Is pain really all in your head—or is that just part of the story?
How much of pain is physical, and how much is psychological?
Can we rewire the way we experience pain?
Why don’t medications always work the way we expect for pain relief?
What does it mean to treat pain with both compassion and science?
Citations:
Stanford and ACPA Chronic Pain guide 2024:
https://www.acpanow.com/uploads/9/9/8/3/99838302/acpa_stanford_resource_guide_2024.pdf
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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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1:13:34
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1:13:34
Freud Enters the Chat: Psychodynamic Therapy
Margaret took the captain’s chair for this one, and I was just along for the ride—straight into the deep waters of psychodynamic and psychoanalytic therapy. We start with the basics: what do these words actually mean, and why do they still make some clinicians roll their eyes while others swear by them? From Freud’s infamous couch to modern relational therapy, we unpack the myths, the methods, and the mysteries that still define this approach.
Along the way, we wrestle with big questions: What’s really happening in the therapeutic relationship? Why does transference matter? And is there value in a therapy that sometimes feels more like philosophy than science?
And because talking about it wasn’t enough, we try it on for size—running a live role-play where I attempt a psychodynamic formulation in real time. (Spoiler: it’s as messy and awkward as you’d imagine, but also revealing in ways I didn’t expect.)
This isn’t a lecture or a history lesson. It’s us exploring why psychodynamic therapy still sparks curiosity, skepticism, and maybe even wonder—and asking what it means for the future of how we help people heal.
Takeaways:
Therapy on the Couch: Why psychoanalysis still matters, even if we roll our eyes at Freud.The Mirror Effect: How transference and countertransference shape every session more than we realize.
Cracks in the Foundation: Why psychodynamic work digs into the “basement” instead of just fixing surface problems.Between Science and Story: The tension between falsifiability and the lived experience of patients.
Practice Makes Awkward: A live role-play that shows just how messy (and revealing) this approach can be.
Citations:
Kassaw K, Gabbard GO. Creating a psychodynamic formulation from a clinical evaluation. Am J Psychiatry. 2002 May;159(5):721-6. doi: 10.1176/appi.ajp.159.5.721. PMID: 11986123.
Summers, R. F., Barber, J. P., & Zilcha-Mano, S. (2024). Psychodynamic therapy: A guide to evidence-based practice (2nd ed.). The Guilford Press. Chapter 1 cited
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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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1:17:48
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1:17:48
Alyson Stoner: What Happens When You Grow Up in the Spotlight?
This episode might feel like a gut punch, in the most important way. Margaret and I sat down with Alyson Stoner to talk about what it means to be raised in the spotlight, what happens when systems prioritize performance over people, and how we reckon with that legacy in healthcare. There’s a vulnerability here that caught me off guard and I think that’s the point. If you’ve ever wondered what lies beneath the polished performances we all grew up watching, this one’s for you.
Takeaways:
The Performance Trap: We unpack how young performers are trained to suppress needs for the sake of applause—and what that does long term.
Behind the Curtain: Alyson shares a raw, unfiltered look at what fame masked, and what it demanded.
Trauma in the Body: We explore how unresolved pain shows up in physical health—and how the body never really forgets.
Reclaiming Identity: From child star to advocate, Alyson walks us through the messy, powerful work of redefinition.
What Healing Can Look Like: It's not about fixing—it’s about reconnecting. And sometimes the most honest therapy isn’t clinical at all.
Want more Alyson Stoner:
IG: @alysonstoner
TikTok: @alysonstoner
YouTube: @TheRealAlysonStoner
Citations:
Orenstein GA, Lewis L. Erikson's Stages of Psychosocial Development. [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556096/
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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
New Zealand