Psychofarm Podcast

Lindsay Clancy’s insanity defense is the focus of this forensic psychiatry follow-up after the mistrial. We revisit the case through the lens of legal insanity, postpartum psychosis, malingering, criminal responsibility, and the difference between a legal conclusion and a moral judgment. We also discuss why psychosis cannot be reduced to a single reported voice, how forensic psychiatrists think about exaggeration versus malingering, questions around expert testimony and diagnosis, and the relationship between psychosis and violence. Finally, we look at medication nonadherence, culpability, how uncommon the insanity defense may be, and what questions arise when someone is found not guilty by reason of insanity.


This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Lindsay Clancy postpartum psychosis and the insanity defense are examined through a forensic psychiatry lens in this episode. We discuss how psychiatrists distinguish psychosis from malingering, whether someone can be psychotic while still appearing organized, command hallucinations, delusions, altruistic filicide, and what criminal responsibility actually asks. We also look at Dr. Philip Resnick’s testimony, Clancy’s psychiatric treatment, fragmented care, collateral information, and the limits of ruling out bipolar disorder after a brief evaluation. Finally, we explore why the case has produced such intense public reactions and why psychiatry often requires tolerating uncertainty rather than forcing complex patients or cases into simple categories.


This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

Affective neuroscience in psychiatry may offer a better way to understand patients who do not fit neatly into DSM categories. Dr. White joins us to explain Jaak Panksepp’s seven primary emotional systems, the difference between affect and emotion, and how subcortical emotional arousal interacts with cortical regulation. We discuss anger, borderline personality disorder, cognitive decline, mindfulness, ACT, emotional blunting with SSRIs, and why some cases labeled treatment-resistant depression may need a better formulation rather than another medication. We also get into the neuroscience behind the model… from decortication and brain-stimulation studies to TMS… and ask what psychiatry loses when diagnosis comes before understanding affect.Dr. White’s Substack:


This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

We put the Seinfeld cast on the proverbial couch, not to slap diagnoses on fictional characters, but to show why personality formulation can tell us far more than a psychiatric label.
Is George a vulnerable narcissist, borderline, or something more complicated? Does Jerry’s obsession with cleanliness and order actually resemble OCD or an obsessive-compulsive personality style? Could Kramer meet criteria for antisocial personality disorder despite being charming, affectionate, and largely nonviolent? And is Elaine secretly the healthiest person in the group?
Along the way, we explore flanderization, narcissism, borderline personality organization, obsessive-compulsive personality traits, psychopathy versus antisocial personality disorder, gambling disorder, and the DSM-5 Alternative Model for Personality Disorders.


This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com

In this episode, the hosts rank the behavioral and medication strategies they use for sleep problems in psychiatric practice, starting with strict wake times, CBT-I, sleep hygiene, exercise, and treating the underlying disorder. They compare doxepin, trazodone, mirtazapine, hydroxyzine, melatonin, gabapentin, benzodiazepines, Z-drugs, antipsychotics, and other options, with attention to sleep onset, sleep maintenance, side effects, dependence, sleep architecture, and comorbid conditions. The conversation also covers caffeine and stimulant timing, alcohol and cannabis, primary sleep disorders, and why diagnosis should guide insomnia treatment before medication choice.


This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit psychofarm.substack.com