27. Modern Day Prophets: What People in Recovery Teach Us About Addiction, Dopamine, and Being Human | Anna Lempke

27. Modern Day Prophets: What People in Recovery Teach Us About Addiction, Dopamine, and Being Human | Anna Lempke

Dr. Anna Lembke on Addiction, Dopamine, and the Joy of Recovery In this episode, Isaac sits down with Dr. Anna Lembke — Stanford psychiatrist, bestselling author of Dopamine Nation, and leading voice in addiction medicine — for a wide-ranging conversation about how she found her calling treating addiction, the science behind why we struggle to stop, and why she believes this work is one of the most rewarding in medicine. Dr. Lembke shares her winding path from Yale to China to Stanford, a pivotal clinical mistake involving a patient addicted to heroin she never thought to ask about, and what that experience taught her about the failures of medical education. Together, she and Isaac discuss the rise of poly-addictions and designer drugs, how to help patients understand cannabis is driving their anxiety, the case for radical self-disclosure in clinical care, and why people in long-term recovery are — in her words — "modern-day prophets." Whether you're a future physician, a curious mind, or someone who has struggled with addiction personally, this conversation will shift how you think about dopamine, healing, and what it means to truly help another person. Topics covered: * Dr. Lembke's circuitous path from pathology to psychiatry to addiction medicine * Emerging addiction patterns: digital media, kratom, designer drugs, and poly-substance use * How to diagnose addiction using the "Four Cs" * The 80/20 rule: why stopping often resolves psychiatric symptoms * Helping patients experiment with abstinence to test their own beliefs * Integrating addiction care across medicine * Advice for medical students choosing a specialty * The power of self-disclosure in the doctor-patient relationship * What she'd keep — and what's evolved — since writing Dopamine Nation You can check out Dr. Lempke's book at Amazon: https://www.amazon.com/Dopamine-Nation-Finding-Balance-Indulgence/dp/152474672X Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/cruen/city-streets License code: 2JJVCBQKEE2GJH5N

26. Practicing Without Distance: Building Child & Adolescent Psychiatry in Rural America | Dr. Martha Karlstad

In this episode, we sit down with Dr. Karlstad, a board-certified child and adolescent psychiatrist who has spent over a decade building mental health infrastructure in rural southwest Wisconsin. As the first mental health professional ever hired within her independent health system—a federally designated rural health clinic serving a five-county region from a town of just 5,000—Dr. Karlstad has built a behavioral health department from the ground up. What began as a single role has grown into an integrated team of a general psychiatrist, a psychiatric nurse practitioner, four psychotherapists, and dedicated nursing staff, all embedded within primary care. Beyond her clinical work, Dr. Karlstad serves as a consultant with the Wisconsin Child Psychiatry Consultation Program (CPCP), a statewide psychiatric access initiative that connects primary care providers with real-time child psychiatry support. Through this role, she extends her reach to thousands of pediatric patients she may never meet, equipping frontline clinicians who carry the bulk of youth mental health care. She is also the president-elect of the Wisconsin Council of Child and Adolescent Psychiatry (WISCCAP), where she is helping lead efforts in legislative advocacy—focusing on Medicaid access, reimbursement, and sustaining care for children with severe and persistent mental illness. This conversation traces Dr. Karlstad’s path into psychiatry—from early aspirations in international primary care to a pivotal third-year rotation—and explores how her commitment to high-need, low-resource populations led her to one of the most underserved regions in rural America. She speaks candidly about the realities of practicing in settings where specialized care may require hours of travel, and where even basic treatments—such as medication-assisted therapy—can demand extraordinary burdens from families. Her clinical philosophy is grounded in evidence-based practice and collaborative decision-making with families, with an emphasis on transparency—especially when options are limited. Most powerfully, Dr. Karlstad reflects on the personal cost of rural practice: the loss of anonymity, the complexity of boundaries in tightly knit communities, and the weight of losing a young patient to suicide in a place where professional and personal lives are inseparable. She reframes burnout not as a single breaking point, but as “death by a thousand cuts,” and shares how diversifying her roles, pursuing her own therapy, and committing to personal growth allowed her to move from questioning the sustainability of this work to believing she can do it for a lifetime. This episode is essential listening for trainees and early-career psychiatrists considering rural or underserved practice—and for anyone wrestling with the intersection of professional identity, community, and systemic responsibility. Dr. Karlstad offers a rare and unfiltered look at what it truly means to build a career—and a life—where the need is greatest. Music from #Uppbeat (free for Creators!):https://uppbeat.io/t/cruen/city-streetsLicense code: 2JJVCBQKEE2GJH5N

25. John Z. Sadler: Philosophy, Ethics, and the Conceptual Foundations of Psychiatry

In this episode, we are honored to welcome Dr. John Z. Sadler, one of the most influential figures at the intersection of psychiatry, ethics, and philosophy. For more than four decades, Dr. Sadler has shaped the intellectual and moral foundations of psychiatric diagnosis, values-based practice, and clinical ethics consultation. Dr. Sadler is the Daniel W. Foster, MD Professor of Medical Ethics and Professor of Psychiatry and Clinical Sciences at UT Southwestern Medical Center, where he directs the Program in Ethics in Science & Medicine and leads the Division of Ethics in the Department of Psychiatry. He has served on the Parkland Hospital Ethics Committee since 1985 and was its co-chair and clinical ethics consultant for three decades—bringing philosophical inquiry directly into the realities of patient care. A co-founder of the Association for the Advancement of Philosophy and Psychiatry and longtime co-editor of Philosophy, Psychiatry, & Psychology, Dr. Sadler has helped define an entire field of scholarship. He is the author of Values and Psychiatric Diagnosis and the recently published Vice and Psychiatric Diagnosis, co-author of The Virtuous Psychiatrist, and editor of multiple definitive reference works including the Oxford Handbook of Philosophy and Psychiatry, the Oxford Handbook of Psychiatric Ethics, and the Oxford Handbook of Psychotherapy Ethics. In this wide-ranging conversation, we explore why philosophy matters in everyday psychiatric practice, from how values shape diagnostic systems like the DSM and ICD, to the ethical tensions that arise in clinical care. Dr. Sadler reflects on the virtues essential to modern psychiatrists, how trainees can cultivate conceptual competence, and where the philosophy of psychiatry is headed globally. The result is both an intellectual masterclass and a thoughtful meditation on what psychiatry is, and what it ought to be. Music from #Uppbeat (free for Creators!):https://uppbeat.io/t/cruen/city-streetsLicense code: 2JJVCBQKEE2GJH5N

24. Inside Leadership, Advocacy, and the Future of Psychiatry with Dr. Mark Rapaport

In this episode of Get Psyched, we’re joined by Dr. Mark Rapaport, 2025 President-Elect of the American Psychiatric Association and one of the most influential academic leaders in modern psychiatry. Dr. Rapaport has had a distinguished career spanning several of the nation’s leading institutions. He has served as CEO of the Huntsman Mental Health Institute and Chair of the Department of Psychiatry at the Spencer Fox Eccles School of Medicine at the University of Utah; Chair of Psychiatry and Behavioral Sciences at Emory University School of Medicine; Chief Psychiatric Officer for Emory Healthcare; founding Co-Director of the Emory Brain Health Center; Chair of Psychiatry and Behavioral Neuroscience at Cedars-Sinai Medical Center; and Vice Chair of Psychiatry at the David Geffen School of Medicine at UCLA. In addition to his leadership roles, Dr. Rapaport is a highly accomplished researcher with more than 200 peer-reviewed publications. He also co-founded and served as Editor-in-Chief of FOCUS: The Journal of Lifelong Learning in Psychiatry, guiding the journal to address emerging clinical topics — including being the first major psychiatric journal to devote an entire issue to LGBTQ+ and underrepresented minority health concerns. In our conversation, Dr. Rapaport reflects on his upbringing, his family’s multigenerational legacy in medicine, and the mentors and patients who shaped his path into psychiatry. We discuss his philosophy of leadership, his passion for academic medicine, and the sometimes winding journey of following one’s curiosities across research, teaching, and clinical care. Whether you’re a medical student, psychiatry trainee, or clinician thinking about leadership, advocacy, or academic medicine, this episode offers an inspiring and thoughtful look at a career devoted to service, mentorship, and advancing the field. Thank you for listening! We are recruiting for several open roles on the Get Psyched podcast team (Editor, Host, Writer, Producer). Here is the application link:https://docs.google.com/forms/d/e/1FAIpQLSfFL4UapBbRxGWiL-V8KNQZslkZF-Gnzf2zI16cNoreGcEmXA/viewform?usp=sharing&ouid=111781906299228250953 Music from #Uppbeat (free for Creators!):https://uppbeat.io/t/cruen/city-streetsLicense code: 2JJVCBQKEE2GJH5N

23. Inside the Mind of Forensic Psychiatry: A Conversation with Dr. Phillip Resnick

In this episode of Get Psyched, we’re joined by one of the most influential figures in forensic psychiatry—Dr. Phillip Resnick, Professor of Psychiatry at Case Western Reserve University and Director of the Division of Forensic Psychiatry at University Hospitals Cleveland Medical Center. Dr. Resnick has consulted on many nationally recognized cases, including those of Jeffrey Dahmer, Theodore Kaczynski, and Andrea Yates, and is widely regarded as an authority on the insanity defense, malingering, filicide, and violence risk assessment. With over 200 publications and decades of experience teaching around the world, he has helped shape the modern practice of forensic psychiatry. Join us as Dr. Resnick shares how he found his path into psychiatry, what it’s like to evaluate defendants in high-profile criminal cases, and how forensic psychiatrists balance science, ethics, and the law. He also offers invaluable insights for trainees interested in this fascinating subspecialty—and reflects on the lessons, challenges, and meaning he’s found over the course of his remarkable career. Whether you’re a medical student, psychiatry trainee, or simply curious about the intersection of mental health and the law, this conversation offers a rare glimpse into the mind of one of the field’s true pioneers. We are going to recruiting for several open roles on the Get Psyched podcast team (Editor, Host, Writer, Producer, and Social Media Coordinator). Here is the application link: https://docs.google.com/forms/d/e/1FAIpQLSfFL4UapBbRxGWiL-V8KNQZslkZF-Gnzf2zI16cNoreGcEmXA/viewform?usp=sharing&ouid=111781906299228250953 Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/cruen/city-streets License code: 2JJVCBQKEE2GJH5N