Show Notes — Neurostimulation Podcast Episode: Who Heals the Healer? Burnout, Shame & the Psychology of High Achievement

Guest: Dr. Stacey Elliott, MD

In this deeply insightful episode, Dr. Michael Passmore sits down with Dr. Stacey Elliott — board-certified psychiatrist, addiction medicine physician, and founder of CNY Integrative Psychiatry — to explore the hidden psychology behind burnout, high achievement, and the often-overlooked emotional lives of high-functioning professionals.

What we cover:

• Why burnout is best understood as a loss of connection with the self, not a personal failure
• How early attachment patterns and subtle childhood adaptations can drive overachievement in adult life
• The surprising overlap between addiction and workaholism — and why both are attempts to manage the same core wound
• The concept of therapeutic prescribing: why the relationship around medication matters as much as the medication itself
• The nocebo effect in psychiatry and what "difficult" patients are often really communicating
• Shame vs. guilt: how shame accumulates in high performers and what it takes to heal it
• The importance of peer consultation, supervision, and Balint groups for clinicians and caregivers
• What it actually means to be authentically well — not just high-functioning

Guest resources:

• Dr. Stacey Elliott's website: www.cnyintegrativepsych.com
• Peer consultation services for clinicians: available via the Specialty tab on her website

Key concepts mentioned:

• Internal Family Systems (IFS)
• Balint groups
• Vicarious stress and compassion fatigue
• Ikigai (the four quadrants of meaningful work)
• Nocebo effect in psychiatric medication

Welcome to the Neurostimulation Podcast.

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I'm Dr.

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Michael Passmore, clinical associate

professor in the Department of

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Psychiatry at the University of

British Columbia in Vancouver, Canada.

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Today I'm podcasting from Squamish,

BC, which is a beautiful part of the

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province that I would encourage you

all to visit if you ever get a chance.

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The Neurostimulation Podcast is all

about exploring the fascinating world

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of neuroscience in general and clinical

neurostimulation in particular.

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We also talk to experts and discuss

research in the field of interventional

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mental health, like ketamine assisted

psychotherapy, and other cutting

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edge innovative treatment options.

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We talk about the latest research, and

importantly how that research is being

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translated into real world treatments

that can improve health and wellbeing.

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So whether you're a healthcare

professional, a student, a researcher,

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or someone who's just really interested

in how our brains work and what we

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can do to help them work better,

this podcast is definitely for you.

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I would mention again that this

podcast is separate from my clinical

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and academic roles, and is part of my

personal effort to bring neuroscience

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education to the general public.

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So I do emphasize that the information

shared here is for educational

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purposes only, and is not intended

as medical advice or a substitute

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for professional medical guidance.

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Stacey: Welcome back to the

Neurostimulation Podcast.

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Today's conversation is one that I

really think will resonate deeply with

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many of you, especially those working

in fields like healthcare leadership,

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really any high performance field where

success on the outside can sometimes mask

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something very different on the inside.

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I'm joined today by Dr.

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Stacey Elliott, a board certified

psychiatrist and addiction medicine

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physician, and the founder of

CNY Integrative Psychiatry.

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Mike: Dr.

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Elliott specializes in working with high

achieving professionals like physicians,

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executives, and driven individuals who

are functioning at a high level, but

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often deal with things like burnout,

exhaustion, disconnection, and a quiet

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sense that something isn't quite right.

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And so I would really encourage

you all viewers and listeners

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to check out her website, which

is www.cnyintegrativepsych.com.

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And for listeners, I'm gonna

spell that out just to make

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sure that you can get it right.

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It's www dot C-N-Y-I-N-T-E-G.

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R-A-T-I-V-E-P-S-Y-C h.com.

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And also for clinicians and caregivers

who are listening or watching.

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I would really encourage you to

focus in on the peer consultation

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section of the website, because

we were just chatting offline, Dr.

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Elliott and I, about how that's

such an important part of her work

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that I would really direct you to.

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So again, Dr.

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Elliott, thank you so

much for joining us today.

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I'm really looking forward

to this conversation.

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It's gonna be so interesting

and so informative.

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So thanks for being here.

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Stacey: Thank you so much.

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It's my pleasure.

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I'm really glad that we

were able to connect.

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Mike: Definitely, yeah.

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Maybe you could take some time to

introduce yourself, talk a bit about

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your background, what's brought

you to where you're at now and

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some of your projects that you're

really excited about these days.

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Stacey: Yeah, absolutely.

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so I am, as you so nicely described

in the introduction, I am a board

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certified psychiatrist, board certified

in addiction medicine as well.

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and I came to psychiatry in

a bit of a roundabout way.

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I was the stereotypical, I knew I

was gonna be a doctor my whole life

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kind of thing, but never really

thought about being a psychiatrist.

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in medical school even.

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I was still thinking I was

probably gonna do OB, GYN.

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I liked being in the or, I liked

the pressure and the intensity.

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but I also really liked

the psychosocial piece.

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I think that was probably the first

point in my life where I listened to

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the internal voice, though that said.

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The environment, what it requires of you

maybe isn't aligned with your core values.

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I, I saw burnout.

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Didn't know that's what it was

called, but I saw burnout all around

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me and the trainees and, and it

just didn't sit right with me, but I

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didn't know what else I wanted to do.

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So I sat in terror for months

thinking, I guess I'm just gonna

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be miserable for my whole career.

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but this is what I'm called to do.

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and then I had my psychiatry rotation and

realized that psychiatry was a field that

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was much broader than I had believed.

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I had a reductionist view of psychiatry,

like you just pump people full of pills

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and go on with your day and, stare at

people blankly, and that's about it.

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And I saw so many incredible things.

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In terms of connecting with people in

the ability to do therapy as a, as a

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clinician, I, I didn't even realize that

was a thing, to be honest with you, I had

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no real exposure to a psychiatrist other

than what I'd gotten from popular culture.

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and I also realized that, that the science

and the art of psychiatry were so unique.

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and over the course of a couple of

weeks of that rotation, I went from

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being totally unsure what I was gonna

do with the rest of my life to how

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could I have ever thought I was gonna

be anything other than a psychiatrist

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and every person I told that to, like my

close friends, my family, every single

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person when I told them was like, huh.

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Oh, of course.

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And, and it, that's what

it happened in my own mind.

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Like there was this moment

of like, wait, what?

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And, and a true, of course,

this is what I was meant to do.

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and I have been so grateful.

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Ever since that I had that opportunity

to reflect a little bit and sit with

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the discomfort of like, Hey, what

I think I know maybe isn't true.

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and see what it meant to listen to that

internal voice and take a different path.

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so I trained at SUNY

Upstate in Central New York.

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I'm a Northeasterner.

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I grew up kind of in this area

and the program I trained at is

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pretty psychodynamically oriented.

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I got a lot of excellent therapy training.

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to be honest, I think of myself

as a therapist who is a physician,

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which has been a unique experience

as I grow a private practice now.

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I worked for the VA for, about

eight years, in several different

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capacities after training, and left va.

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Service fully, last year and launched

my private practice, which is what

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I do and spend most of my time

in professionally at this point.

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Fantastic.

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Yeah.

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Such an inspiring story, and I think

this, I really appreciate you sharing the

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journey that you had with coming to terms

with that authentic, that kind of, yeah.

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Coming to terms with that authentic self

and realizing that, because I wonder if,

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I mean, I've certainly had similar kinds

of thoughts throughout training, partly

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because I guess, there's, there's nothing

in a sense, there's nothing wrong with,

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in fact, it's helpful often to know at

an early age what you're kind of called

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to do, but sometimes getting onto a

certain track and, being in high pressure

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educational environments at a relatively

young age, or having certain expectations

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that can maybe interfere with someone's.

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Staying in touch with

their truly authentic self.

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So coming to terms with that, or

perhaps not being able to come to terms

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with, not being able to come to terms

with that might actually be a risk

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factor for burnout, would you say?

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Speaker 3: Yeah.

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Oh, I think absolutely.

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I think that's one of the number one

risk factors of burnout is not having

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the capacity either because we haven't

had it modeled for us or reflected to

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us, how to take space and to ref and to

look inward, but also when the culture

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doesn't give us the time to do it.

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and I think our modern

culture is so fast-paced.

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There isn't room oftentimes to stop

and think and be rested and reflective.

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We're just moving on to the next

thing and then we lose the muscle that

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we need to sit in that discomfort.

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Like it, it's uncomfortable to

sit with your own thoughts and

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when we don't practice doing that.

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We become intolerant of it, and then

we're just kind of stuck on a cycle of

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doing things because that's what we know

to do and it doesn't feel quite right,

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but we don't even have the room to

consider what different could look like.

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Mike: Yeah, for sure, for sure.

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I mean, and it's a very common term

because it's a pervasive issue.

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Sometimes people though,

struggle to define it.

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What would you say, would be your

favorite definition, or characterization

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of burnout, and then how might that

tie in with other kinds of concerns

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like depression or anxiety clinically?

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Speaker 3: Yeah, so I think that

burnout, I think, the way I describe

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it really does align with the true

definition, and I'm gonna come at it

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from that psychodynamic perspective.

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It's this loss of

connection with the self.

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I think that's really what burnout is.

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You are going through the motions,

you are living in reality, but

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you're not connected to your core

self, to your values, to your joy.

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you no longer see the

fruits of your labor.

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And it doesn't always have to be

in the sense of paid labor either.

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Burnout is common in, in caregiving,

in with, aging parents and aging

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loved ones as well as with children.

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but it's essentially that like

disconnection from the self I

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think is really the core of it.

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And it can masquerade as DSM

five psychiatric diagnoses.

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It can also be a driver of the

development of those things.

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And I think that's a place in

psychiatry where we have to be

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really careful of over pathologizing.

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And I see that a lot in my

work where people come to me

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thinking they need medication.

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And sometimes they do.

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Oftentimes they do.

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Stacey: But a lot of times what they

need is that time and attention and, and

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the, a container for their distress so

that they can look at it, observe it, and

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then actually ask questions about what's

happening in their life to make changes so

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they don't have to feel that way anymore.

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You

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can't think your way out of a

lot of things, but thinking about

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things is pretty important, to start

addressing symptoms of burnout.

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Yeah.

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Yeah, that's really helpful.

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Very interesting.

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'cause I can imagine that particularly

through training and then early career,

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a lot of high functioning professionals

probably have their identity very wrapped

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up in, in what they've been trained to

do, in what they're feeling good at.

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they might be finding the sweet

spot in the Iki guy diagram, between

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the four quadrants of what you're

good at, what the world needs, what

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pays the bills, and, where your pa

where your passion is, I suppose.

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Right.

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So finding that and feeling en

invested in that and feeling good

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about it on the one hand, but on the

other hand, maybe having a GNA sense

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that something's not quite right.

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Yes.

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so it must have to do with this

question of how to define authenticity.

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And as you're saying, there's

probably a whole lot of value in

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people providing themselves with

the space to kind of explore that if

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they do get a sense, annoying sense

that something's not quite right.

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Speaker 3: Absolutely.

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And I think that's, that's the

essential work of therapy is

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making, I mean, you're literally

making space in the therapy room.

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As a therapist, you are the one

providing the space as a consumer

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of therapy as a client to patient.

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You are making an effort and,

at least, superficially to

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create that space for yourself.

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But it's so, I see it so commonly that

people don't allow that space to be made.

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There are so many reasons

why you can't do it.

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You can't invest in it.

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Well, my work schedule doesn't allow it.

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I can't, I don't have, time off.

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My kids need me.

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My, this needs me, my, that needs me.

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And all of those things are

real tensions and yet all of the

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energy that you're draining out.

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Could be put to the use of one

hour of therapy in a week, 10

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minutes of meditation in a day.

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And yet we see those things slip

away because the grind that's

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started that drove the burnout in

the first place doesn't go away.

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Stacey: For sure.

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For sure.

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Yeah.

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It's so interesting, because as

you say, there can be these hidden

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psychodynamic factors that lead someone

to be, hard on themselves, right.

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And not forgiving and not to

allow themselves the space.

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If it's a few minutes every day for

some quiet time, some meditation.

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There's a, there's, I think it must

be so common in part of how high

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functioning individuals get to that

point in the first place is this ethos

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of very hard work and, perhaps at the

expense of self-care and self-compassion.

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Speaker 3: Yeah, absolutely.

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It feels often.

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I think, and I, this happened to me

when I started the private practice and

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I realized how much more as opposed to

space and time being a luxury, which is

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how I always viewed it, I realized that

it was actually a necessity I could not

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do and cannot do the work that I do.

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Well if I don't remain incredibly sharp.

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And I've known this my whole career as

a psychiatrist, that in, in medicine

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in general and in mental health

in particular, you are the tool.

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You are, in most cases, the.

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I truly believe that it is not just, okay,

here's your prescription for fluoxetine.

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Like that is not the value.

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The value is in the relationship that we

have, in my reflection of your goodness,

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in my patience with your ambivalence.

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but that is not an easy thing to provide

day over day, hour over hour to let

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people borrow your central nervous system.

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And if you are not keeping

yourself regulated and authentic,

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you can't do the work very well.

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And that's a challenge because that's

at odds with, I think, a cultural belief

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that we have in our North American culture

and in the culture of medicine that to

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rest, to take care of oneself, to do

things that make you feel good is selfish.

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Everyone else comes first.

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Speaker 2: And

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Speaker 3: you're kind of

left with what's left over.

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Stacey: Mm-hmm.

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Definitely.

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There's this idea that I think is

really relevant here, and that is

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the idea that it's really could be

conceived of as an occupational.

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I mean, I, I hesitate to say hazard,

but it's at least an occupational, risk.

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And that is this idea of

vicarious stress, right?

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So, and especially with considering

things like mirror neurons and so if

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an individual, if we take a caregiver,

a clinician, a healthcare worker,

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a helper, if they're faced day in

and day out in their vocation with.

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Trying their best to help people,

but hearing the challenging stories

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and the complaints that people are

bringing then, and sometimes awful

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stories, awful situations, obviously

then that, that risks because of things

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like mirror neurons that risks the

clinician also vicariously experiencing

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a lot of that stress and trauma.

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And so that by itself is probably

another huge risk factor for

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burnout and compassion fatigue.

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Speaker 3: Absolutely.

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Absolutely.

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And I think of all of our colleagues

in medicine who are not in

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psychiatry, who don't even have the

infrastructure within their training

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to, to acknowledge that often.

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I mean, as much as, I used to, when I went

into psychiatry, I didn't even know that

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psychiatry residency was four years long.

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I thought it was three years.

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and then I was like, four years.

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Why is it four years?

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You can do internal

medicine in three years?

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And then I went through it

and I realized so much of.

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The training, especially in the

third and fourth year, is about

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consolidating all of that information.

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It's the psychopharmacology you

can learn much more quickly.

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It's the presence, the therapeutic

presence that, the time that you

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need in individual supervision to, to

learn how to regulate yourself in the

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service of supporting your patients.

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And even with all of that training

and knowledge, you still then

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transition into life as an attending.

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And a lot of that goes right out the

window with just trying to figure out

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how to be a real grownup doctor now.

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and I think that it, I'm so grateful

that I had such a strong program that

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was so therapeutically supportive

because I didn't lose sight of that.

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Even if it felt like I was sometimes

getting dragged along and then I would

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remember like, I need to seek out.

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Support and I would reach out to peers

and I would reach out to old faculty

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and supervisors, and I was really

lucky to have a great, chief in my

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department who I could go to with

all kinds of, questions and problems.

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But I can see how easily you can lose

sight of that, those touch points.

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And that's a quick road to

burnout when there's no time or

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space between, all these patients

jammed in one after another.

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I don't have time to talk about this

case, like I wanna get home, so I wanna

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use this time to write a couple notes.

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But really you need to use that

time to offload some of the distress

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so that you actually have more

space, can be more present, and

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then be more efficient over time.

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One day you may go home late, but

over the course of a career, you're

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gonna have a much lighter load.

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Stacey: Totally.

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Yeah, absolutely.

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And it kind of brings us back to

this whole idea offline beforehand

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we touched on the idea of what

are called balance groups.

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And so for listeners who can't see the

captions, it's ba, B-A-L-I-N-T, I forget

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that psychiatrist's first name, but

he pioneered this idea of clinicians

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gathering together and supporting one

another, discussion of challenging

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case situations, discussions of how

they're also maybe having trouble

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themselves with emotions or certain

kinds of things that needed to be

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worked through in a group setting.

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So I think both of us would really

encourage clinicians to consider.

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Finding out if there's a balance group

nearby, if that might be something that

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your professional association might offer.

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And if not, maybe start one

up yourself and have that as

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a resource for colleagues.

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'cause I think that can be super helpful.

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So talk a bit about maybe your peer

consultation offering there at CNY

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integrative psych as it relates

to what we're talking about here.

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Speaker 3: Yeah, so I would say that one

of the things that I was really lucky

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to have in my work in the VA system

was like a ready made structure of

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colleagues who we could share cases with.

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in the Department of Veterans

Affairs, it's more of a collaborative

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model in a lot of ways, both within

mental health, but also within.

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Among primary care and

the other specialties.

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all of the records are shared and

it's pretty easy to communicate

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with your colleagues asynchronously

or in real time, in a way that I

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feel like I was really spoiled.

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I could talk to somebody's primary

care provider sometimes in real time,

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but within the day about issues,

and really coordinate care well.

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that's something that is very different

in almost every other healthcare setting.

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I call primary care

providers now all the time.

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The primary care providers with

my, private practice patients, and

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they're like shocked that it's me

on the phone, not my assistant, but

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I wanna talk to the other provider.

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sometimes it takes a little bit of,

of insistence, but, I, I'll get on the

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phone and we'll talk for 10 minutes

and we can solve a problem that could

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have taken months to get resolved.

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but.

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In addition, sometimes you realize

that things are coming out and

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you're both seeing something

from a different perspective.

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And like that five minute conversation

is suddenly like, oh my gosh, I spent

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all this time worrying about X, Y, or Z.

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Or oh, you noticed this and

I noticed this, and together

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we can come to a conclusion.

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And I just think that like mind's

thinking alongside one another, it's

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such a valuable resource that we

don't often put enough emphasis on.

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Like we're, we get so siloed

in our day-to-day work, and

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there's so much work to be done.

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I'm speaking as a healthcare provider,

but in almost every field nowadays,

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there's so many regulations, there's

so much technology, there's so many

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demands on our time that we don't

actually like, have the ability to

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just commune with other people and let

our thoughts flow and something about.

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That isolation is really disheartening.

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and I try to combat that with my own

practice now by, I have, casual groups

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that I meet with for supervision,

and that's not really supervision.

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It's more just like, what's it like to

be a private practitioner and how are we

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getting through these business challenges

and that are also clinical challenges.

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but also I have my own therapy that

I am able to invest in and I've been

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in for years, but now it's like even

more, I'm even more focused on it.

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and then I pay for clinical

supervision so that my therapy, it,

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my therapeutic work is done well.

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and in doing that and realizing the

value in that, like that's one of

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the largest financial investments in

my practice is my own supervision.

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I realized that's a culture that can.

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Can quickly be lost.

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And I, I don't want that

to be lost in psychiatry.

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this acknowledgement that we are

better when we think together

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as opposed to having to be this

like knowing all, knowing expert.

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Like you can read a lot of papers,

but sometimes you need to talk about

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things and see things from different

angles and turn it upside down.

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And it's hard to do that alone.

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Mike: Totally, totally.

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It's so inspiring.

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I think that psychiatry as a field

could really do better in terms of

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encouraging other fields in medicine to

have more of a formalized system, call

378

it supervision, call it mentorship or

something where there is that, as you

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say, it's a really important investment

in one's own health and practice.

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Value for sure as well, because it,

the benefit obviously is gonna come

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off with improved patient care, right?

382

I mean, patients are gonna, clients

are gonna recognize that the care

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is of greater value than in other

situations where they may have had,

384

and it's very common, not a disparaging

comment, but clinicians who are frankly

385

burnt out or on the verge of it.

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And that shows in the way that the

therapeutic relationship might not be

387

as good as it could be otherwise, right?

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Stacey: Absolutely, absolutely.

389

And I'm sure we've all, all experienced

it as, in, in the sense of like,

390

everyone has shown up to a doctor's

appointment or a healthcare appointment

391

and you're like, oh, that person's

having a bad day, or things are really

392

rushed, or you can tell, they're just

like, please don't say one more thing.

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And that's being human.

394

Part of that is just being human.

395

you're never gonna show up a hundred

percent all of the time, but if you can

396

create the space to do the work, to be

able to show up a little bit better.

397

It's gonna pay itself off in spades.

398

Mm-hmm.

399

But it's hard.

400

It's hard.

401

Yeah, for sure.

402

Yeah.

403

Time is a limited resource.

404

Mike: Well, this is the thing.

405

It's finding that balance

is very challenging.

406

But I think, what's, what would probably

be really interesting for clinicians and

407

caregivers, really anyone, I mean like,

I don't really want this to be limited

408

in a sense for the audience to healthcare

professionals or caregivers per se.

409

'cause it struck me that,

that any job really relates to

410

helping another person, right?

411

Providing any service related job is,

is a helping kind of an endeavor, right?

412

And so I wonder though that from your

experience with these sorts of, high

413

performers in whatever sector we're

talking about, it strikes me that without

414

perhaps getting overly analytical about

it, but one of the most interesting

415

ideas that I've found in your work

is this idea that high achievement

416

itself can be a kind of an adaptation,

maybe sometimes even a mal adaptation.

417

So can you talk to us a little bit about

how things like early attachment or subtle

418

trauma can show up in overachievers?

419

Oh, absolutely.

420

So it's so interesting because,

people, people will joke when they

421

find out I'm a psychiatrist, like

my kids', parents, friends' parents,

422

or, oh, do you analyze everybody?

423

Do you diagnose everybody?

424

And I'm like, no, actually, it just

makes me say like, oh, that's the reason.

425

But it, I, I think it makes me be

curious and, compassionate in that way.

426

But, so I don't wanna pathologize

achievement and but there is oftentimes,

427

what helps us to be very good often in

our work may be one side of a coin that

428

can, if, too much emphasis is put on it.

429

Cause challenges in other

places in our lives.

430

we, we become who we are because

of our early environments.

431

our, our genes, obviously nature

and nurture and, we are, we

432

are because of a lot of things.

433

But when, when particular characteristics

are, are, get us good feedback, either

434

explicitly or implicitly, we're gonna

keep doing them like we're animals.

435

We adapt to our environment and we

look for the path of least resistance.

436

So if being a kid who brings home

all a's is the thing that makes your

437

parents stop bickering at the dinner

table, like you might try really hard

438

to bring home all a's, but then you're

40 years old and your parents aren't

439

bickering at the dinner table anymore.

440

But that same feeling that you get inside.

441

From something else may evoke

that drive to I gotta do better.

442

I gotta do better.

443

and when we are, are unconscious

is what's driving our behaviors.

444

Sometimes we lose sight

of the path that we're on.

445

and suddenly the working really hard is

getting us an excellent report at work.

446

People really like us.

447

We're getting promoted and we're making

more money and we have a lot of value in

448

that, in that setting, but it's at the

expense of maybe our partnership or our

449

relationship with our children because

we're not showing up in that place.

450

And that's quieter.

451

Those relationships may not be

pulling in the same way and saying,

452

Hey, I need you over here, or

they are and it's uncomfortable.

453

Because it's asking you to, to,

to tone down this one aspect of

454

yourself that has brought you so much

success and, maybe even psychological

455

protection from, from some of the

distress that you're experiencing.

456

And that's, that's hard to look at.

457

Mm-hmm.

458

Yeah.

459

This is so important.

460

I can imagine a lot of the audience is

really resonating with this 'cause it's

461

very, very common, and I think it's so

fascinating because you, I understand

462

that you also work in addiction medicine,

and I was struck by your idea that

463

addiction and achievement can be two

sides of the same coping strategy.

464

I guess it's not a coincidence that the

term workaholic is adopted from alcoholic.

465

So are you able to expand

on that a little for us?

466

Stacey: Absolutely.

467

I've become really interested in,

internal family systems as a, I

468

guess like a framework for looking

at the way people present and their,

469

their symptomatology and the, the.

470

The points of distress in their lives.

471

I, I'm not trained in IFS, I'm not

gonna say I'm an if FS therapist, but

472

for me, it's really my understanding.

473

It's really aligned and supported

that psychodynamic view that I take.

474

and in IFS for those who aren't familiar,

very simplified explanation, we look

475

at ourselves as thinking creatures have

many, many parts of the mind, not in a

476

pathological way, just that's how we are.

477

and our parts sometimes will

develop very strong stances that

478

are meant to protect the whole self.

479

Generally from a young age and in

our lives, we will all of us go

480

through, things that are tumultuous

and, and even traumatic and parts

481

can get really stuck in, a role.

482

That role is meant to, to create

a safe safety for the self.

483

But then fast forward 10, 15, 20 years,

that self is actually an adult who's

484

autonomous, has, has agency and choice.

485

But those parts may still be

really stuck in, in their old role.

486

and they may look like

what we call managers.

487

Those are like adaptive seeming

parts that, are really diligent and

488

people pleasing and, and look good

to everybody else, but, but are

489

not authentic, to the core self.

490

The flip side would be like firefighters.

491

These are parts that are just like, burn

it to the, we gotta stop the fire, but

492

it may look really messy on the way.

493

and those are parts that show

up, all in the, in the purpose of

494

the same thing, to stop feeling

uncomfortable, to feel safe and secure.

495

so somebody may.

496

Invoke parts that are more

in that workaholic space.

497

I work really hard and I make

people happy, and I don't say no.

498

And work is the place where I look the

best and feel the best because I have

499

been able to, create a scenario around

me where like I am, I am competent.

500

This is where I demonstrate my competence.

501

But then I go back to the rest of

my life with my partnership with a

502

marriage where like, actually I have

a really hard time with conflict and I

503

like am either screaming at my spouse

or like hiding, hiding and avoiding.

504

but when I go to work, I am actually an

excellent boss and people respect me.

505

So I'm going to wanna spend more time in

that place where I feel and look good.

506

That's a socially

sanctioned way of managing.

507

Parts of ourselves that need to

grow and, and learn new ways of

508

being so we can be authentic.

509

Addiction is a part of the self that's

gone a more dangerous, physiologically

510

unhealthy, psychologically unhealthy

root that is not so socially sanctioned,

511

but at its core, they're all ways

of trying to, to help ourselves.

512

Nobody does things.

513

All human behavior is at the service

of, of like keeping the self safe.

514

It just may look really crazy, literally

crazy sometimes on the outside.

515

But internally it, the goal is the same.

516

and I think that that is really a hard

thing for a lot of people to imagine.

517

And it's easier to judge.

518

The decisions of someone who is

using substances or, addic, addictive

519

behaviors to say that they're

bad or that they, they made that

520

choice and it's, it's their fault.

521

And then we have, like I said, these more

socially sanctioned ways of mitigating

522

our distress that, that seem okay.

523

but really the, the core

wound is still there.

524

It just looks different.

525

Mm, mm-hmm.

526

Yeah.

527

That's such a, an amazing,

eloquent way of explaining it.

528

So thanks so much for that.

529

It's it idea and probably

it's why burnout and.

530

Things like compassion fatigue can

be so insidious and are so pervasive

531

because it is, it's beneath the

surface, but, but the behavior that's

532

leading to it is socially encouraged,

not only socially acceptable, but

533

socially encouraged and for good reason.

534

I mean, it's not a matter of of denying

the importance of productivity and high

535

performance by itself, but it's just

a matter of finding the balance and

536

helping to give people some direction

in times when they do start to feel

537

that there's something not quite right

with their true, authentic selves.

538

Mm-hmm.

539

Absolutely.

540

Absolutely.

541

And again, that space.

542

Mm-hmm.

543

Creating that space to be

able to ask that question.

544

To get curious, yeah.

545

What's happening here.

546

Yeah.

547

Yeah.

548

And I guess there's this interesting

link from a neurochemical perspective

549

in terms of dopamine regulation playing

into both overachievement and addiction,

550

and then how those things can then.

551

Get one, one can start to feed the other,

I suppose, with things like stimulant

552

addiction and other kinds of, even alcohol

I suppose as well, just in terms of the

553

way that it, that any kind of stimulating

substance can interfere with proper

554

dopa healthy, dopaminergic functioning.

555

Absolutely, absolutely.

556

Yeah.

557

It's interesting because I was, talking

to a, a colleague recently about

558

burnout and, as a college colleague.

559

So we were talking about, from my

perspective and, and how medication plays

560

in to burnout and, and the, the idea

of stimulants came up and, I, I take

561

a, an interesting stance, but I hold

very formally to this, that, sometimes

562

with stimulants in particular, we find

ourselves in this, this dance around,

563

My is, is my role as specifically as a

psychiatrist, not just as a physician,

564

but as a psychiatrist in particular.

565

my role is to diagnose, to

treat and to do no harm.

566

And am I doing harm if I, if I feed into

the fantasy that you have, that you can

567

work and be on high alert for 16, 18,

20 hours, sleep for four and get back

568

up and do it again and again and again.

569

And I think that in our, our field, we run

into that challenge over and over again

570

with people, who present with symptoms

that align with the DSM diagnosis for

571

A DHD, and they get put on high dose

stimulants and there's still not enough.

572

And then they need a booster.

573

And at what point do we stop and

say, maybe this is not physiology.

574

Maybe this is a fantasy that you or anyone

could remain on alert for this long.

575

You're gonna be really mad when

I tell you that because you can't

576

do the things that you believe

you can or should be able to do.

577

and I think that that's a really

interesting, parallel probably, it

578

is somehow related in my mind to

addiction and not in the sense that

579

you're addicted to the stimulant, but

the idea that that fantasy, that like

580

something can be different than it

is that I could, I can drink all day

581

and not create chaos in my life, that

I could take stimulants and not have

582

sleep problems and appetite issues and,

chronic pain from not caring for my body.

583

Mm-hmm.

584

Yeah.

585

Yeah.

586

And like you said earlier, it's, it's

often about there being a deep wound that

587

people are, are not as conscious of as

they might be with perhaps some therapy,

588

some space as we're talking about,

and then doing their best to try to.

589

Treat the wound in maladaptive ways,

maybe ways that work initially,

590

but that in the end they don't work

well or they make the wound worse.

591

Yes, yes, absolutely.

592

Mm-hmm.

593

I really, I, I really love the

concept that you've, shared about

594

therapeutic prescribing that,

that I've seen in your work.

595

Maybe can you explain a little

bit about what that means?

596

'cause I think that a lot of the time

with medication prescribing, people

597

are, people are a little bit, wary

or reluctant, and I think obviously

598

medications can be very helpful.

599

They definitely have a, an

important place in the toolkit.

600

But how does your concept of therapeutic

prescribing work for your practice?

601

Yeah, absolutely.

602

I think, I think that's one of

the main reasons that people find

603

their way to working with me.

604

a lot of referrals from colleagues

of, oh, this is somebody who's really

605

nervous about medication, or, like,

they're scared of it and they've

606

never tried it, and, and they're quite

symptomatic and other evidence-based

607

interventions haven't worked or are not

working as effectively as we'd expect.

608

or people who, on the flip side have had

tons of medication trials, but they've

609

tried everything, so now they're scared

of what's, is there anything left?

610

What's gonna happen if you

try something different?

611

and I actually had a, a supervisor

in residency, who was an amazing

612

psychiatrist, trained before there

were pretty much any medications in

613

psychiatry, and, and was a therapist.

614

I, I don't think I ever

saw him prescribe anything.

615

He was a child psychiatrist and

did a lot of family therapy.

616

but he was one of my supervisors

and he would've described himself.

617

He's, he's since passed away,

but he would've described himself

618

as an eclectic psychiatrist.

619

And that really was the best way to

describe his approach, was very eclectic.

620

But he is the first person to

ever said to me, what you do,

621

it's therapeutic prescribing.

622

And I, I, that meant a lot to me because

it reflected to me something that I

623

didn't realize was, probably the thing

that called me to psychiatry, which is

624

the fact that the act of prescribing is

not just writing that prescription on

625

a piece of paper, putting it into your

computer and sending it to the pharmacy.

626

Mental health medications,

psychiatric medications are unique.

627

We, we have research to show this

now that the nocebo effect can

628

actually sometimes be greater

than the placebo effect, and that.

629

The idea that the way you think about

the medication you're taking could

630

actually affect how it, it works on

the brain is so fascinating to me.

631

Um, and I think that it's, um, it can

be scary to think about it like that.

632

Like, oh my God, but you can't, you know,

you can't think your blood pressure down

633

if you don't like propranolol, you know?

634

Mm-hmm.

635

Or you do like propranolol or, you

know, and, and in, in psychiatry,

636

I think we have to acknowledge the

fact that people have feelings about

637

the medication that they're taking.

638

Um, there is a lot of bias

and stigma around even needing

639

to have mental health care.

640

Um, and it's so important to give

people the time and space to deal with

641

the ambivalence that they might have.

642

And that's how I see a lot of what.

643

Could look like and is often

labeled as medication noncompliance.

644

difficult patients, people who are,

they don't follow the treatment plan.

645

they are, highly sensitive

to, to medication effects.

646

All of these things are data points.

647

They're, it's all information about what

that person's internal experience is like.

648

and it can be really frustrating.

649

Like, I'm the first one to admit,

like, I would much rather have somebody

650

come in say, I'm really anxious.

651

they score, moderately high score on

a, on a GAD seven, and I give them five

652

milligrams of Lexapro and like two weeks

later they're like, wow, I feel great.

653

This is amazing.

654

I have no side effects

and everything's great.

655

Like, that's a very easy patient.

656

That's lovely.

657

Mm-hmm.

658

But that is not as common as

somebody who has a lot of.

659

Other worries.

660

And they heard something about a, a

medication and they wanna understand,

661

well if this happens to this person

and, or this thing happened to me.

662

And I just think that it's so

important to create that space.

663

Like the actual deciding what

pill to give somebody is one

664

of the easier parts of my work.

665

It's how do I hold the

space for their ambivalence?

666

How do I explain without overexplaining,

how do I give them the respect as an

667

autonomous person, but also the support

that they deserve from a trusted guide.

668

and I, I think that that is such a

value in psychiatry that, a lot of us

669

could take more advantage of, like, we

do have these skills to hold space and

670

to be thera a therapeutic presence.

671

we're physicians and we're scientists, and

it's, it's like holding that balance of.

672

You've got this really crazy idea

that you read about, like, let's

673

get curious about it together.

674

I might not support that.

675

I might, have to say,

well, I respectfully defer.

676

I, I don't, I don't see the data in that,

but I can hear what you're saying and,

677

and I can pull a nugget out of that.

678

Oh, so what I'm hearing is you

are really worried about, weight

679

gain with these medications.

680

'cause you've heard that, let's

talk about that as opposed to some,

681

crazy idea that like has no basis in

science, that's just a red herring.

682

Really what you're scared of is

that this medication is gonna

683

cause you to put on 50 pounds.

684

So let's talk about that and if there

are other alternatives and options,

685

or you're scared that if you take this

medication it means that you are crazy.

686

Like let's talk about that.

687

and I think that that goes a

long way in helping people to

688

actually engage in evidence-based

or evidence-informed treatment.

689

Which can help them get better.

690

Yeah, definitely.

691

The whole idea of the no SIBO

effect is really interesting.

692

So, as just for viewers and listeners

that might not be familiar, I, as I

693

understand, correct me if I'm wrong,

but it's this idea that, that the,

694

the expectation of a side effect or

a negative outcome can actually be

695

a factor that in the end produces

that, like a self-fulfilling prophecy.

696

Is that correct?

697

Yes, that is correct.

698

So the idea, yeah, that you're, you're

essentially inducing, what you feared

699

from a, from a psychological perspective.

700

and it's fascinating because it in

some ways defies the science, and

701

it's, but it's really va I think

it's also really valuable information

702

to consider, when people show up in

that way to 'cause it, it reminds us

703

that each person is an individual.

704

And all of our data is based on large

cohorts, and these are generalizable

705

things, but the person sitting in

front of you is not an amalgamation

706

of all of the people who were ever

studied with this intervention.

707

They're the one person sitting in front of

you with their one own unique experience.

708

And it's learning to find that

balance, I think, and hold that.

709

I know that every single person

that I've ever treated who took

710

Drug X had, this result and not this

side effect, but you're telling me

711

you had the opposite experience.

712

That's that's the reality

that it happened to you.

713

And even if it really wasn't objectively

real, that's what you know and let's

714

like put that and give that some,

some validity and see how we can work

715

around that instead of just holding a

dogmatic like, nope, can't be that way.

716

Mm-hmm.

717

I think that, that happens a lot.

718

It's hard.

719

It's hard and it's, it comes back

to again, I guess this thing where.

720

Kind of part of the overachieving

feeling as though overcoming, or maybe

721

not so much the imposter syndrome, but

then still feeling like, okay, well

722

I must all of this education, all of

this training, all of this, all these

723

accolades must stand for something.

724

So, so it is kind of like my way or the

highway or feeling definitive against that

725

and feeling like, okay, well, like, and

then that, putting the barrier there so

726

that you're not actually connecting with

that client at the level that they need,

727

or you're not actually, I think there's

a, there's, there's a call to curiosity

728

as you say, but also humility, right?

729

This idea of epistemic humility or

humility about, well, 'cause the hard

730

thing is that it goes against the grain

in terms of like hardcore science to a

731

certain extent, because we feel like, oh,

well, if there's evidence-based medicine,

732

then by the stats, then this is probably

the best chance that this person has.

733

And if they're.

734

Complaining of something that doesn't

make sense as a side effect, then

735

they're, like you say in quotes,

difficult client or whatever.

736

But, but maybe the, the, the clinician

might be challenged to try to approach

737

it more from the perspective of curiosity

and humility and say, well, is there a

738

question behind the complaint of this

unlikely side effect that is really

739

at the core of what I might be able to

help this person with from a relational

740

and a psychotherapeutic perspective?

741

Yes, absolutely.

742

And I think you hit the nail on the head

with that, that piece about humility.

743

It's so hard, in, in our field of

medicine, and I think in many, in

744

many fields where you have a lot

of responsibility and part of the

745

socialization of becoming a physician is.

746

You kind of have to like, not really

look that in the eye because it's,

747

it's scary, it's overwhelming.

748

and but the downside of that, the

dark side of that is sometimes

749

you, you lose some of your humility

because you have to know everything.

750

'cause that's the, that's

the societal expectation.

751

And in reality, we're all fallible humans.

752

and we're all learning still continuously.

753

Yeah.

754

Well, it ties in with one of

the other things I was hoping

755

to touch on, and that's what I

think is one of the most powerful

756

themes in your work and and theme.

757

The theme is shame, especially in

high functioning professionals.

758

Shame at.

759

various degrees, I suppose this perhaps

betrayal to the self because of that

760

sense that there's something inauthentic

about what they've been successful at,

761

or shame in in another way of, of having

hidden maladaptive coping mechanisms

762

like addictions and, and perhaps some

degree of dysfunction outside of the

763

workplace at home and with family.

764

So maybe, if you don't mind

sharing some of your insights about

765

shame and, and how that relates

to what we've been discussing.

766

Oh, absolutely.

767

so, shame, I guess the, the most basic

ne definition of shame and what is

768

often, Dances in partnership is guilt.

769

and I, I see guilt as an experience

of I have done something wrong.

770

in its adaptive sense, guilt is a

social signal, oh, I made a mistake.

771

I am acknowledging with empathy that

other people have lived experiences.

772

I will take this opportunity if possible,

to repair and then hopefully learn and

773

do better or differently in the future.

774

guilt over time can erode and become

more insidious, and that's, I think

775

when it shifts to shame, which is not,

I have done something bad, but I am bad.

776

And that is a deeper wound and it is

exquisitely painful, almost physically

777

painful, and in, for some people

truly physically painful to look at.

778

And we will do nearly

anything to put that shame.

779

Somewhere else so that we

don't have to look at it.

780

and I think that you often see with

high achieving people this space

781

between what they believe they should

be or the reality should be, and

782

then what reality is, and in that

space is where guilt starts to grow.

783

I am not a good enough parent.

784

I am not a good enough employee.

785

I am not a, competent enough person.

786

I got here by mistake.

787

and if we have those beliefs for long

enough, if we sit with that guilt for long

788

enough, it coalesces into a real sense

of shame about our, about our au ourself.

789

We don't see that we are, a valuable self.

790

And how do we address this shame?

791

How do we get rid of it?

792

In an ideal world, we'd all be in therapy.

793

And we'd sit with another human every week

who'd reflect to us our goodness and hold

794

for us that pain and ambivalence until

we could bring it out into the light and

795

start to unpack it and understand it.

796

But unfortunately, most of us don't

have the opportunity to do that.

797

And in a lot of ways, our shame is

reinforced by other external factors.

798

And if we can't manage it within

our own heads, we're gonna do

799

other things to get rid of it.

800

Like using substances, engaging in

unhelpful, unhealthy behaviors, or

801

doing socially sanctioned things

that distract us from, from our,

802

from our emotional distress.

803

Mike: Mm-hmm.

804

Stacey: Yeah.

805

Shame is, shame is pervasive and it's a,

a human experience, but it doesn't have

806

to be the thing that that drives us.

807

Yeah.

808

Well, thanks for explaining that.

809

I think it's just very valuable

to, to know about it, to be able

810

to name it and to describe it and

to understand that it is pervasive.

811

and yeah, connected to this idea that, I,

I'd mentioned just in a previous episode

812

that, one of my great mentors in training

almost an off the cuff comment during

813

a lecture one time, said that we're all

traumatized to one degree or another at

814

some point, generally early on in life.

815

And so, the shame and guilt that can

come out of early life trauma and

816

adversity, is pretty much universal.

817

And so for people to just understand

that it's not just them that,

818

they can get help for that.

819

So for someone listening or

watching right now, maybe.

820

A clinician or an executive or other

high performer, but not necessarily

821

anyone who's listening who feels like

they're running on empty, what might be

822

some first steps for them to consider?

823

Speaker 3: The first thing

I would tell somebody to do

824

is to find a good therapist.

825

To be honest with you, I think that

it's so important to be able to sit

826

with someone who has done some of

that own their own internal work.

827

So what they really can reflect

back to you is your authentic self.

828

We are human beings.

829

We need connection and we need

to be in community with others.

830

And sometimes we find that we are in

community with so many others who are

831

sharing the same burdens that we are.

832

And it can feel really hard.

833

To find a place where we

can unburden ourselves.

834

and I guess finding community, finding

people who are like-minded and can sit

835

with you and accept you as you are.

836

And sometimes the place to do that is,

is first in therapy so that you can

837

really start to open up space within

yourself so that you can be that light

838

to others and attract a community

of people who, who support you as

839

opposed to driving you deeper into

those places of shame and avoidance.

840

Mike: Yeah, absolutely.

841

Thanks so much for that.

842

And I guess maybe just to branch

out from that a little bit and maybe

843

finish off on an optimistic tone.

844

I'm just so curious to know some of

your thoughts about from your wisdom

845

and your experience, what have you

found that actually means to be, well,

846

I know it's a big question, but not

just high functioning, but genuinely,

847

authentically well and thriving in that,

in that really optimal sense that people,

848

I think a lot of the time are craving

and, and that they hope for and they're

849

just not quite sure how to get there.

850

But what could be a, a gold star if you,

or a north, north star, if you will, that

851

people can look towards aiming, aiming

at in, in terms of helping themselves to

852

optimize their health and, and wellness.

853

Speaker 3: Absolutely.

854

I think this is such a great question.

855

It's something that I've been thinking

a lot about in the last year as my

856

life has changed very dramatically

with my work and my family.

857

And, what, what are, what's it all for?

858

Why am I doing the work that I do?

859

And what, what's the goal?

860

And I've realized that for me, and

I, I think for for many people,

861

what, well, what wellness is, is

to live in, in a place where you

862

feel that you are connecting with

the world at your highest capacity.

863

That the things that you're called to

do, your, your talents, your vocation is,

864

is able to be, you're able to engage in

that in a way that feels connected and

865

that you're, you're able to approach the

world in a curious and compassionate way,

866

that we are also able to feel comfort

in our physical bodies and in our minds.

867

I think wellness can sometimes be focused

only on the physical body and how I

868

look and, and how my, athletic capacity,

for example, but at the expense of.

869

High stress and, and angst.

870

and it's finding that balance of being

comfortable in our, within our bodies

871

and within our minds and within the world

around us and the community that we've

872

built, and insert us ourselves into.

873

Mike: Perfect.

874

Yeah, what a great definition.

875

I love it.

876

That's, just so inspiring and a

great, a great place to sort of, end

877

off, with, and I think it's just,

been such a great conversation.

878

thank you again, Dr.

879

Stacey Elliott.

880

just really a delight and, again,

for viewers and listeners, I would

881

really encourage you to check out Dr.

882

Elliottt's website, which is

cny integrative psych.com,

883

so www CNY integrative psych.com.

884

And particularly for clinicians,

the peer consultation section there.

885

I think that would be something that I'd

highly, recommend that you check out.

886

yeah, I mean, such an

interesting conversation.

887

I think that what stands out most

to me is this idea that burnout is

888

certainly not a personal failure.

889

It's often a signal, a signal

that there's something perhaps

890

in the system, whether it's.

891

Internal or external that

needs care and attention.

892

self-care, self-compassion.

893

So just allowing yourself to have access

to the space to come to terms with that,

894

to find a therapist that we've, like

we've been talking about, so that there

895

can be some exploration around that.

896

And, that there's always hope, that

with, with recognizing that maybe there's

897

a concern, and having the courage to

come forward to ask these difficult

898

questions and to seek help that I often

tell clients that's more than half

899

the battle, just having the courage

to come forward and try to get help.

900

But there is hope that, that,

that wellness is achievable.

901

and hopefully, some of the things that

we've been talking about today will

902

help provide people with the tools that

they need to, take those steps forward

903

and, and getting themselves some help

if, if they're really struggling.

904

Speaker 4: Absolutely.

905

Stacey: Super.

906

Well, thanks again.

907

And yeah.

908

just for viewers and listeners, if

you've enjoyed this podcast episode,

909

please like and subscribe, share it with

colleagues, friends, anyone that you think

910

might benefit from this conversation.

911

And again, Dr.

912

Elliott, thanks so much

for being here today.

913

It's been so great to have

this conversation with you.

914

It's been lovely to meet you and just

wish you all the best with all of

915

your exciting projects going forward.

916

Speaker 2: Wonderful.

917

Thank you so much.

918

Stacey: Okay.

919

Take care.

920

All the best.

921

Bye.

922

Speaker 2: Bye-bye.

923

Stacey: Thanks again to Dr.

924

Stacey Elliottt for such a thoughtful

and deeply relevant conversation.

925

I think what stood out most to me is

this idea that burnout is not a personal

926

failure, but it's often a signal.

927

A signal that something in the

system, whether it's internal or

928

external, needs care and attention.

929

And for those of us working in

healthcare or high demand fields, the

930

question who heals the healer is not

just philosophical, it's essential.

931

Thanks so much for joining us today

on the Neurostimulation Podcast.

932

I really hope that you enjoyed

this exploration into this

933

fascinating topic as much as I did.

934

If you found today's episode

interesting, don't forget to like

935

and subscribe to the podcast.

936

It really is the best way to

make sure that you never miss an

937

episode, and it helps us to reach

more curious minds like yours.

938

Also, if you think that today's

episode might resonate with a

939

friend, a family member, or a

colleague, please share it with them.

940

This kind of knowledge really is

better when it's shared and you

941

never know who might find this

information helpful or inspiring.

942

For more details about Dr.

943

Elliott's work that we discussed

today, her current projects and

944

all of her content, please do check

out the links in the show notes.

945

You'll find everything that you

need to dive deeper into the topic,

946

and I'd love to hear your thoughts.

947

So please join the conversation

in the comment section or

948

reach out on social media.

949

Your questions, ideas, and feedback

really do make this podcast better.

950

Finally, don't forget to

tune into the next episode.

951

It's going to be another exciting journey

into the cutting edge of neuroscience,

952

clinical neurostimulation, interventional

mental health, general mental health and

953

wellness, and so we'll see you next time.

954

Thanks again for listening.

955

Take care.

956

Stay curious, and I'll see you again

on the Neurostimulation Podcast.