Bipolar Breakdowns with Clinical Psychiatrist Dr. Kay Jamison

KKH Trailer Wide


Will: [00:00:00] Knock,

knock, knock. Hi. Hello. Welcome to Knock-knock High with the Glock Pluckings. I got, uh, the one and only. Kristen Flannery, also known as Lady Glock Flecking here. And then there’s you and me. You got, yeah. You know, you know Will 

Kristin: Flannery, Dr. Glock, Dr. 

Will: So Dr. Dr. G, Dr. Glock flocking. I’ve also gotten Dr.

Glockenspiel once. No one’s my favorite. Uh, Dr. Glock. Fln. I, you know, it’s, it’s really endless. It’s your own fault 

Kristin: for choosing the, the word. Yep. 

Will: Could have done something a little easier. Anyway, um, we got a, a fascinating show today. Yes. Very, very interesting conversation with Dr. Kay Jameson. Uh, but before we get to Dr.

Jameson, uh, what’s going on with us? I just got [00:01:00] back. You got to a solo parent mm-hmm. For 

Kristin: a couple days. For the weekend. Yep. Yep, yep, yep. That was, uh, fun. 

Will: Yep. Mm-hmm. While I was off, uh, at a neurosurgery conference. Mm-hmm. My first 

Kristin: neurosurgery conference. You know, you, you have the hair for it right now.


Will: neurology. I know, but it’s close enough. It’s, it’s they’re brothers. I do. So here’s the deal. My, they have the same hair. I am way overdue for a haircut. Everybody. But my, my, and this is a little extra of me, but I, I’m very attached to my hair person. 

Kristin: Well, as we all are, when you find a good one for you.

Right. You 

Will: stick with it. I’ve never had a bad haircut from her and she is on maternity leave. Yeah. And so, um, I’ve already asked her to just, you know, leave the ba or bring the baby with her. Leave the baby. Don’t leave the baby. Bring the baby. Abandon your child. I, I will, will do. I will hold the baby while, oh, you would love 

Kristin: that.

You always have baby fever. You love a good baby. I love a good 

Will: baby. No. [00:02:00] Um, so anyway, I am, uh, why are we even talking about, oh, I’m just, I’m due for a haircut. Yeah. And, uh, I do have neurologist hair, but this was not neurology. This was 

Kristin: IAnd the difference. But they have very similar hair. Your 

Will: two characters.

And in my videos, they’re brothers. That’s what I’m saying. I mean, they could all be related to each other, but maybe they are. No, no, that’s too much. You don’t know. I think I do know, not even I’m creating this uni universe 

Kristin: myself, all of the world building in 

Will: this place. I, I, it’s all up in my head. I got it.

It’s there. But anyway, uh, I was in la uh, staying right next to the crypto center where there were like playoff games going on, which is kind of cool. But Did you see anybody in the games? I, I did. I saw in my, in the elevator, uh, there was somebody, what was the elevator? Is the el in the elevator? There was a member of the Memphis Grizzlies.

Mm. Who was, uh, on the elevator with me, so, yeah. And did you know that 

Kristin: ahead of time? 

Will: No. Well, he got on. I didn’t get a [00:03:00] good look at him. All, all I knew is very tall. Right. 

Kristin: That’s what would’ve super tall, would’ve given it 

Will: away. But it was a, a great conference. I, you know, it’s fun going to these different conferences because I get a, a, a little sense, a much better sense of what.

People are like, mm-hmm. What these specialists are like out in the wild. In the wild. Uh, one recurring theme though is that, You know, there, there are certain specialties that you’ve have this perception of them as being kind of angry. Mm-hmm. And mean. So like cardiologists, I’m always talking about that.

Uh, neurosurgeons, just surgeons in general. Mm-hmm. But across the board, whenever I go to a conference and I hang out with these people at a conference, everyone is so happy. It’s almost like being in the hospital makes you miserable. Oh, imagine that. It’s amazing. Yeah. Everyone is so happy to just be.

Socializing, socializing, not thinking about work. Uh, 

Kristin: maybe having a few beverages, some good meals, even [00:04:00] neurosurgeons 

Will: to sleep at night. Even Neurosur, who I just assumed, like, would it, it would take, uh, just a, some kind of herculean effort to get any neurosurgeon away from the operating room into a conference.

But there were, it was a good turnout and it was a great. Great, uh, experience. Did any 

Kristin: of them have like, you know, those baby monitor, like nanny cam things where you can watch your baby sleeping? Did any of them have those set up for their operating rooms while they were gone? Yeah, 

Will: absolutely. Yes. To make sure that general surgeons didn’t take their operating time.

Yeah, yeah. No, they didn’t do that, but I did kind of expect there to be like, Uh, in the exhibit hall there to be like an emotional support operating room for people. Mm-hmm. Mm-hmm. Yeah. They could just go to just case feel comfortable. Right? Yeah. You know, at some, some conferences they have little, like puppies you can play with.

Yeah. Uh, but sensory chamber, like exactly just like a little operating room, like a fully functioning operating, you could just put on some scrubs and go sit there and pretend to. Be in your happy place. Yeah. I don’t know, but no. Nope, they did not have that 

Kristin: well business idea for someone out there. 

Will: [00:05:00] There you go.

This, uh, you guys could, uh, do that, uh, the a, a and s and others. All right. Let’s get to our guest. So we have, uh, Dr. Kay Redfield Jameson. She’s a professor of psychiatry at the Johns Hopkins University School of Medicine. And is a, a prolific author? Yes. And just a wonder. So it’s very good. Uh, she’s written, um, um, several very famous books.

Uh, the first of which was an Unquiet Mind, which, um, uh, was published back in the nineties. And it was about her, uh, experience, uh, with, with, uh, bipolar disorder. Yeah. 

Kristin: I actually had it as assigned reading in college. Um, yeah, in. What was then called my Abnormal Psychology class. I don’t know if it has a, a different name nowadays, but I remember, uh, that that book really along with the rest of the reading list, it really made an impact on me in terms of like thinking about mental illness and de-stigmatizing it and thinking about it as a.[00:06:00] 

A biological thing that’s happening and how it must affect everyone’s lives and, and what it’s like to have to experience that. It was very 

Will: interesting, very influential book as well. And, uh, she’s been at Johns Hopkins, um, for, um, for decades and is a staple in, in the psychiatry department there. Mm-hmm.

And so, uh, it was a wonderful to talk with her. She is, uh, just one of the leading academics on mental health and mental illness. Dr. Jameson also has a new book out. Called fires in the dark, healing the Unquiet Mind. So we’ll be talking a little bit about her new book as well. A fascinating, fascinating, uh, book about the, basically the cultural history of the treatment and healing of mental suffering.

And, um, so let’s get to our conversation with Dr. Jameson.

All right. Well, we, it is just such a pleasure to welcome you, Dr. Jameson, to, uh, to the [00:07:00] podcast here today. Thank you for joining us. 

Dr. Kay Jamison: Sure. Delighted. 

Will: Uh, so I, I’d like to start off, uh, by talking about your very influential work, uh, an Unquiet Mind, which you wrote. Back in 1995, I believe. Right. What were you doing from a professional standpoint at that time in your life?

Because right now you’re at Johns Hopkins. Where were you at that 

Dr. Kay Jamison: point? Right. I was a, a professor of psychiatry at Johns Hopkins. 

Will: Yeah. Oh, okay. What year was it when you started working at Johns Hopkins? 

Dr. Kay Jamison: Uh, 87. 1987. Oh, okay. And the last ice age. Yeah. 

Will: And so, um, you were, you were working as a psychotherapist at Johns Hopkins and, um, 

Dr. Kay Jamison: at that time yeah, I was a, a researcher and teacher and, uh, yeah, there, uh, 

Will: yeah.[00:08:00] 

And what was it that prompted you to, to write such a personal. Personal account of, of your own mental 

Kristin: illness, especially at that time. Yeah, it’s gotten a little more common now, but at that time I’m sure that was not very common. 

Dr. Kay Jamison: Uh, no, it, it really wasn’t very common. And you’ve got me why I did it. I mean, uh, I did, I did it a lot because people weren’t doing it, I suppose, and, you know, bipolar illness is a, a bad illness to have and I think like all mental illnesses it.

Makes you feel very alone. Mm-hmm. Uh, and uninformed and like, there’s nobody else that has this particular problem. So I wanted to write a book about, you know, how difficult it was to live with it, but also that you could get through it. Were 

Will: you, were you nervous about publishing that given the, the climate around mental health?

She’s nervous. 

Dr. Kay Jamison: Yeah. Uh, well, yes, and for professional reason, I was absolutely. Mm-hmm. And so [00:09:00] the few times in my life, I’m not anxious. I, I’m kind of moods obviously, but not anxiety and I was really anxious. Uh, my, yeah, I was about, Uh, you know, mainly privacy. You know, you don’t mm-hmm. Mm-hmm. Go around talking about these things.

You certainly did then, but also professional reasons. I, I didn’t, I have licenses and I had hospital privileges and, um, you know, I didn’t know if I would still have a job and, you know, what would happen? 

Kristin: That was incredibly brave then. I mean, to potentially be sacrificing all of that in order to publish that book.

That was, that’s 

Will: amazing. What, what was the reaction to, from your medical colleagues, from the people you interacted with on a day-to-day basis? Um, I 

Dr. Kay Jamison: would say overwhelmingly positive with a lot of, um, horror, loved, and in my, when I went to the chairman of my department at Hopkins. He was, and I started saying, oh, you know, I, I don’t wanna put Hopkins in a difficult [00:10:00] position.

There are legal issues, they’re ethical issues, they’re teaching issues, clinical issues. Um, But I, I did feel like it was important for people to know that professionals suffer a lot for mental illness and, uh, that it was good to be open about it. And he said, you know, Kay, you have it all wrong. You have it absolutely backwards.

Uh, when Professor Halsted, who was the first. Chief of surgery at Johns Hopkins, uh, when people in the faculty knew he had a cocaine addiction and a morphine addiction, and Osler, uh, who was chair of medicine at the time, um, said, you know, basically I have your back. Uh, you know, and, and the faculty took it upon themselves to make sure that Halsted could continue to practice when he was well and to teach young surgeons.

And he said, if, if Hopkins can’t do that for you, Hopkins has no business being in business. So he, he gave me the support, [00:11:00] you know, a great teaching hospital. Amazing. He, he sent me off to have lunch with the, with the president of the Hopkins Hospital who said exactly the same thing. Uh, if anybody gives you any trouble, I want to hear about it.

Yeah. Um, so now this is not, trust me, this is not typical of. Medical schools around the country. It’s, is, is right. It’s atypical, but exemplary. 

Kristin: Yeah. That’s a really incredible example And, and ahead of 

Will: their time. Yeah. Dr. Halsted, you mentioned Dr. Halsted, uh, who is, I believe accredited for the, um, the outrageous working hours that were kind of thrust upon.

Residents and, and medical trainees for years. Uh, and, and, uh, so it’s, um, certainly I feel like we’ve come a long way, you know, in terms of understanding those pressures and that it’s not good for mental health, physical health either. 

Dr. Kay Jamison: Certainly true. On the other hand, he also introduced [00:12:00] rubber gloves and uh, 

Will: so he wasn’t all dad.

That’s, well, 

Dr. Kay Jamison: I’m a con. I think he, you know, that was just thread of procedure being brutal to, to house death. Yeah. Right. 

Kristin: Yeah. And I love that this ties into just, you know, The, the complicated messiness that it is to be a human being, right? We like to have these narratives of, there’s good people and there’s bad people, and there’s good things that happen and bad things that happen, but in reality, people are just people and we all are multifaceted and have, you know, good things about us and quote bad things about us.

And, and you know, it’s about finding that balance between the two. It’s not about, you know, deifying one and vilifying another. 

Dr. Kay Jamison: Absolutely. And it’s, it’s a legacy in medicine. If you got rid of all the people who had been outrageous, uh, you would lose an awful lot of people. You know who you know. I mean, [00:13:00] Halsted trained Harvey Cushing.

Cushing was no. General pussy cat, but he also went into the brain at a time when nobody would. And you know, so there, there are, and, and in the arts, I mean, soon, not just medicine in the arts and rest of the sciences. 

Will: Yes. I, I just, I just returned from a neurosurgery, uh, conference where I, I spoke there and, uh, uh, Cushing’s face is all over the place and so Yes, yes, yes.

Certainly. Um, yes. These people had just a huge influence on, on medicine, but the, you mentioned the, uh, the anxiety you had, the fear you had Yeah. In coming out with your story and your illness. Uh, but you know, much to your surprise, it sounds like you, the response was, um, understanding that you got from, from, uh, you know, the people in your life.

Were any of your fears I would say, Yeah, I was gonna ask if any of your fears were, were actually, you know, [00:14:00] came to light. Did you? Oh, for, 

Dr. Kay Jamison: did you? For sure. Yeah, for sure. Yeah. I mean, I think I had the support of my department. I had the support of my colleagues, I think mostly. Mm-hmm. Uh, there was a certain amount of very uncomfortable silence.

It has to be said, you know, that people, once you’ve written that you’ve been psychotic and manic and done. Inordinately embarrassing things and you’ve tried to kill yourself. This creates a certain, um, discomfort in, in some people Sure. Say least, uh, and for, you know, probably for good cause. But, um, I think it by and large in, in my medical colleagues were terrific.

So definite exceptions. It’s, I think the general public for the most part too is wonderful. But there are a lot of people, you know, when people talk about stigma, Um, you know, I got hundreds of letters basically saying that, uh, I should, I would die in hell. I would live in hell for the rest of my life. Uh, you know, that, um, I had sinned if I’d prayed enough, [00:15:00] often enough, well enough, I wouldn’t have had bipolar illness.

You know, there was a lot of vitriol out there and there’s a lot of fear and, um, ignorance. Um, And I go was on the receiving end of it. Long of it. 

Will: Were you, were you seeing patients at this time? Were, were you, did you have an active, you know, practice? Practice? 

Dr. Kay Jamison: I, I did. I had, um, a considerable practice in Washington, which is where I was living and commuting to, to Hopkins.

Um, and I loved it and I loved seeing patients, but I. Talked with a couple of my colleagues and asked them their advice about whether they thought it was a good idea to continue seeing patients, and basically they said no. Uh, and I think that that was good advice, uh, for a lot of reasons. Yeah. 

Will: Um, it’s interesting.

You, you, you know what, what. What came to my mind talking about all the [00:16:00] letters that were sent to you, um, just really nasty things, uh, being told to you was, in my world, in this day and age, it’s, it’s social media, right? So mm-hmm. If, if, if you went pub, if you go public with an, an illness, I’ll just use myself as an example.

You know, I had a, a cardiac arrest and a couple cancer diagnosis, which is, which is very different than obviously a mental illness. But, uh, I do think that the way times have changed now is that it would be a much more, a much more immediate public reaction to, uh, coming out with a, a mental illness. And I have to think probably a little bit more positive than, than maybe, than it would’ve been, um, you know, in the, in the eighties or nineties.

Do you feel like we’ve come a long way in terms of just accepting. Mental illness and just the immediate reaction that people have to it. [00:17:00] Or do Or no. Or no? Yeah. Yeah. Do we 

Dr. Kay Jamison: have a long way to go? Yeah, I would say. Okay. I would answered both of you. Yes and no. Um, yeah. Uh, sure. I think people know a lot more than they used to.

You know, the very fact that Prozac arrives, you know, in a major and everybody thought this was solved, all psychiatric problems was really a good thing. I mean, completely oversold. It, it was, you know, Drug company hype, whatever. But it was a drug that worked and people started talking about depression and that was a really good thing.

And so all the times that people used to, you know, haul over in the corner and say, I have a friend who’s depressed, all of a sudden we’re talking about their own depressions, uh, o much more openly. And I think that’s been a good thing. And I think that people do know more. I mean that the fact that there are a lot of medications out there that work, uh, that people have more.

Comfort talking about psychotherapy probably than they used to. Mm-hmm. I think, I think what’s happened [00:18:00] is in a way it’s gotten a lot mushed up so that mental health has become mushed up with mental illness. So in some ways that’s probably a good thing because it, it takes away some of the stigma and other ways.

It takes away from the fact that these really are illnesses. Mm-hmm. And it trivializes them. So, you know, it’s, we run the risk in a way. Um, of, of trivializing very bad illnesses. So I, I, I think it’s complicated. I think one, one good thing about the pandemic, uh, not a whole lot of good things you could say about it, but one good thing is that people had their kids around them a lot and saw there’s a lot of disturbance out there and it’s real, and that there, you know, there just aren’t enough psychiatrists and psychologists.


Kristin: where, right. You know? Absolutely. Yeah. It’s really hard. Even in a metro area like where we are, it’s hard to find anyone that has openings even now, even three [00:19:00] years in. 

Will: Yeah. And in your, in your most recent, um, your most recent book, which we’ll talk about here in a little bit. Um, you talk about kind of the, the, the, the state of psychotherapy and kinda where it is today and this, um, uh, the idea that, you know, there’s therapy but there’s all, there’s psychotherapy, but there’s also medication and.

Um, that it’s, it’s like a, it’s kind of a balance between the two, right? That, that they compliment each other. Uh, do you feel like we’re going in the right direction in terms of how we are treating mental illness, in terms of finding that balance? Probably not. 

Dr. Kay Jamison: Um, I think that, you know, for like clinical depression, The evidence has been pretty clear for a long time that the combination of psychotherapy and medication is better than either one alone.

Uh, so we, that’s been around just in the books, I [00:20:00] mean, is, and, and, and in the scientific literature, the clinical literature. Um, if you look at clinical practice, you know, psychiatrists just end up do, spending a lot of their time prescribing drugs, which is not. Hugely interesting. Uh, it’s not quite, A lot of people went into psychiatry.

People want in because they were interested in life stories and, and making people suffer less and so forth. So I think that, you know, insurance companies don’t cover psychotherapy very much. Uh, it’s expensive. Um mm-hmm. Medications are much more seen within the medical model. Um, so I think, you know, a, a, again, I think it’s a mixture.

I think people have more fe favorable feelings about medication, which is great. Uh, because the, the hurdle before was getting people to acknowledge that there was something good for medication. I think we’ve perhaps swung too far and not acknowledging how important psychotherapy could be. 

Will: Yeah. And, and I’m, I’m [00:21:00] sure the time constraints that people have now, you know, with our healthcare system, make it even more challenging.

Kristin: Right. So much faster and easier just to prescribe a pill or just to take a pill than, you know, spend the time to faster, 

Dr. Kay Jamison: cheaper. Yeah. And, and also, you know, and one of the things that, again, that came out of the pandemic is that, um, at Hopkins we were studying tele telepsychiatry. And I thought, well, yeah, sure.

Patients may well cotton onto this and like it better. Mm-hmm. Because they don’t have to drive into East Baltimore. They, you know, 

Kristin: park car, especially if you’re depressed. I 

Dr. Kay Jamison: mean, seven day. Yeah, yeah, exactly. Or anxious or anything. Yeah. Uh, you know, or, or normal. Or normal. Uh, but the, the, the problem I thought would be with the, with the doctors, but it wasn’t the doctors.

The doctors actually liked to tell a psychiatry a lot. And that Oh really? Says, you know, and that’s really, and that’s really quite wonderful once they got over, I mean, Hopkins has a very like three or four hour very systematic evaluation in person. And [00:22:00] that I think everybody regarded as, you couldn’t, couldn’t exchange that.

But once beyond that, that you could do a lot of psychiatry, psychiatric practice. And people found it more satisfying than they, than they reckoned. 

Will: I’m, I’m so glad that there are specialties that really embraced, uh, telemedicine because it was miserable. As an ophthalmologist, I’ll tell you, it’s uh, maybe one of the worst things I’ve ever had to endure is trying to diagnose eye problems over a.

At times pretty terrible internet connection, so 

Dr. Kay Jamison: yes. Well, I mean, as I mentioned, my husband’s a cardiologist and I mean, the idea of doing telemedicine is like, you know, I’ll do your heart next. I mean, you know, 

Will: certainly, certainly works for, for some specialties better than others. Yeah. But I, I wanted to talk a little bit more about, um, about your personal experience, uh, with, with bipolar, with manic depression.

[00:23:00] Um, Because I feel like there’s a lot of knowledge. There’s a, there’s a lot of, you go on social media, you see a lot of people talking about mental illness and a lot of it’s surrounding, um, you know, depression and, and burnout and, and anxiety. Um, tell us about, about mania because I, I think that that is, is something that’s not really well known in terms of the symptoms and, and what that looks like.

Uh, and so can you just give us a little bit of your experience? 

Dr. Kay Jamison: Sure. I mean, I maybe as actually like depression has been described long, long before Hippocrates, so it’s been around forever. Mm-hmm. In really good clinical description. Um, so it was particularly kind of fiery madness. And if you think of depression as being a, uh, Completely sluggish state, uh, no energy, uh, low mood, uh, self-loathing, uh, incapable of thinking, [00:24:00] uh, not just rationally, but thinking at all, just confused, ruminating, and so forth, like a hamster wheel.

Uh, suicidal mania is, is almost the opposite in sense that. People’s mood are usually is elevated, expansive, high, uh, euphoric, uh, people feel it, one with the universe. They feel like, you know, um, commune with God or are God, uh, depending on the stage of mania. Um, and it’s a what? Highly irritable, highly volatile state, high energy, high voltage.

So people have just limitless energy. They stay up all night. They don’t sleep. They sleep go without sleeping. Night after night, after night. They are impulsive, um, occasionally violent. They and assaultive, they talk nonstop. They talk very rapidly. Um, they are, um, irrational about purchasing things. You know, I mean, [00:25:00] mania is the only illness in, in medicine where there’s a, uh, one of the diagnostic criteria is spending too much money.

Um mm-hmm. So that’s actually one feature of mania. And in fact, if you get a group of people who have been manic in a group, Very often the, the Old War stories will center around what outrageous things did you buy, you know, and Right. How did you pay them off and, you know, uh, whatever. So it’s it, but it’s a hyper, hyper, hyper state.

Um, it’s, it’s very often confused, um, and not uncommonly and, and understandably sometimes by the police as being a drug-induced state, you know, that you’re, oh yeah. Amphetamine, they’re cocaine and so forth. 

Kristin: Is it, uh, um, you know, I know you talk about, you have another book about exuberance, which exuberance feels very positive to experience.

Is mania similar in that way or different? 

Dr. Kay Jamison: Um, it’s sim similar in its mild forms. Okay. The trouble with [00:26:00] mania, I mean, if you could keep mania at it in this mild forms, you know, Everyone would sign up for it in a heartbeat, right? I mean, it’s like, you know who would want more? It’s like a constant good mood.

I mean, yeah, you’d have to be pretty disturb Dean. Not to, to want that. And that’s, that’s kind of a hyper form of exuberance. But trouble with mania is that it, it becomes, Uh, really pathological and psychotic. So people, most people who have, you know, stage three mania, for example, hallucinate, have delusions, are incredibly reckless.


Kristin: do we know anything about, so I’m not in medicine or attached to the medical field in any way except that I’m married to an ophthalmologist. That’s it. So maybe you guys already know this, but do we know anything about the neurochemical? You know, underlying mechanisms of depression and mania. Are they the same mechanisms or are these two different systems, or what do we know about how that’s working on [00:27:00] a, on a biological level?

Dr. Kay Jamison: Um, well, we know first and foremost with bipolar illnesses, genetic, okay. So it’s, it’s one of the most, next to autism, one of the most genetic illnesses in psychiatry is really highly heritable. Um, so if you raise. You know, identical twins, that one twin is raised with non-biological parents in LA and another in Copenhagen, uh, which is kind of the gold standard of genetic studies.

You find that, uh, there’s like 80 to 90% if one, if, if one twin has bipolar, the other twin likely, so. Mm-hmm. I, what’s, what’s con a bit confusing is that in the old European. Literature, people thought of rheumatic depressive illness as also including recurrent depression. So what we know is, uh, people who didn’t, who never showed mania, in [00:28:00] fact, who have very recurrent depressions.

Look much more genetically in terms of also the course, the illness treatment response wise, they look much more like bipolar illness than they do major depression. So it gets Oh, interesting. Very complicated in there. And that’s one of the major, you know, diagnostic. Problems that comes up. But we do, to answer your question, yes, we know a lot.

We know a lot from neuroimaging, we know a lot from neurobiology. Very complicated, but a lot of really sophisticated and elegant science. I mean, it’s, yeah, just in the last 10, 15 years, it’s, it’s been remarkable. Yeah. Cause a 

Kristin: lot of the symptoms seem kind of opposite, you know, between the two. So I’m just curious if maybe some of the, the mechanisms are, you know, just.

The same mechanism, but other, you know, each opposite ends of that mechanism for the two. 

Dr. Kay Jamison: Mm. Yeah, I think very definitely. So, um, okay. You know, it, it’s the, the jury’s out, but I think so. Yeah. Yeah. [00:29:00] 

Will: Well, I have to obvi you’re very o open with your own illness and so I wanted to ask you about, we talked about the, the, the symptoms, the things that can happen to someone who’s in a manic episode.

And, uh, I have to ask you about the snake bite kits. So you, you’ve talked about that before. I thought that was a very fascinating, interesting manifestation of your illness. 

Dr. Kay Jamison: Uh, yeah, I think, and again, I think if you talk to anybody who’s been manic, uh, you know, it’s, it’s just a, it’s different stories.

Same, same. Yeah, sure. Right. So, uh, when I got, I, I had gotten. Sort of mildly manic in high school and then severely suicidally depressed my senior year. And then I went bouncing around and never got psychically manic until I joined the faculty as assistant professor at UCLA in the psychiatry department and Mitch.

Um, and one of the things that [00:30:00] happens to you when you’re manic is you get very certain. About things that may or may not be true. I mean, um, the word delusion comes to mind, but you also just get kind of paranoid and kind of convinced that you can do certain things or that you should protect people. So one of the first things that happened to me when I got really manic was in LA there are actually a lot of snakes.

I mean, in fairness to my psychosis, there are actually a lot of snakes. Sure. Um, and so, I had this sense that there was a major rattlesnake problem in the San Fernando Valley. Pretty specific, but a lot of snakes. And so I went out and I went to a pharmacy at the same time that I was filling my prescription for lithium, my first prescription for lithium.

I gave my prescription over to the pharmacist and then I went around filling up my cart. Um, and in my cart I had like a dozen snake bite kits. Because I wanted [00:31:00] all of my friends to be protected. Mm-hmm. And so, uh, when I went to pick up my prescription, the pharmacist looked, you know, just 

Kristin: put two and two together.


Dr. Kay Jamison: You, and it’s interesting. I gave one of the sneak bike kits to my psychiatrist and I was joking. Oh, maybe a year or so ago there was an article about, actually there was a snake in F station in the San Fernando Valley. And so I emailed him and I said, I rest my case. You know, I’m, 

Kristin: you were just ahead of your time.

Dr. Kay Jamison: And he’s That’s right. And he said, you know, I still have that snake bike. 

Will: Oh my gosh. Oh wow. That’s so interesting. Uh, and so is it, you know, if you’ve had, if you get multiple. Over time, multiple episodes, manic episodes, do they tend to manifest the same way for a person? Like would it, [00:32:00] would it be the same for you if like maybe six months you had another episode?

Um, or, uh, do you find that there are differences in those manic episodes? 

Dr. Kay Jamison: Well, if, if you look at the old literature, one of the problems is that everything is compounded. In this day and age by medication. So if people, if you have a mood disorder and say you were depressed and then you took antidepressants, that can precipitate mania and can make you really, really agitated and give you a form of mania that you might not otherwise have had.

So you might have had euphoric banus, which is about 50% of people get medic or, um, Very paranoid and irritable manic manias, which is about the other 50%. So in, so it, for the most part, the old literature where it was not complicated by medications, people were pretty consistent. Manic episode do manic episode in terms of the manifestations of the symptoms, how [00:33:00] they came on, the first symptoms and so forth, and the course.

Um, so there is, there is a certain, I mean, if I got. If I stopped my lithium and I got manic, I, I, I could pretty much guess how that would play. Yeah, 

Will: right. Fascinating. Yeah. Well, let’s take a, let’s take a quick break and we’ll be right back with Dr. Jameson.

Hey, Kristen. Do you know why a stethoscope is so hard to use? 

Kristin: Um, because there’s no heartbeat in an eyeball. 

Will: That’s actually a really good point, but also the heart is quiet. The, the, the sounds are somewhat distant and sometimes you’re in a noisy environment and you’re trying to listen to all the, the beeps and beeps and whatever other noises there are in the heart.

Uh, but with Echo health, 3M Litman Core Digital Stethoscope, it’s easier than ever. You get 40 times sound amplification, active background, noise cancellation. Honestly, even an ophthalmologist could figure it out. 

Kristin: I also really could have used one of those before I had to do [00:34:00] 10 minutes of CPR on you. It leads to earlier detection, better outcomes, something that’s definitely meaningful for 

Will: us.

And we have a special offer for our US listeners. Visit h and use code knock 50 to experience echo’s digital stethoscope technology. That’s E K O health slash kk. And use knock 50 to get $50 off, plus a free case, plus free engraving with this exclusive offer. A big thank you to all our listeners.

Spread the Love. Share this podcast with everyone you know, every single person, everybody as like every person you know. Leave a rating and review. Be honest. You can tell us what you think. We wanna improve this thing as we go. Uh, later today, we’re gonna share some of your own medical stories. You can share yours at knock-knock high human

We also have a Patreon. Come hang out with other members of this community. Uh, early episode [00:35:00] access, check out bonus episodes where we react to medical shows and movies, and it’s just a lot of fun. So come hang out with us.

All right, we are back with Dr. K Jameson. Uh, and um, what I want to talk about right now is something that. Has been on the minds of people in medical education and medical training. Uh, really certainly during the pandemic, but even before that, for the last five, 10 years, I feel like it’s, it’s an issue that’s been gaining a lot of attention, and that’s just, uh, burnout, mental health, especially for young doctors.

Pre-meds, med students, trainees, uh, and, and you are, have been in an, uh, at Johns Hopkins, you know, for, for, um, you know, quite a while and have seen a lot of med students, a lot of trainees over the years. Uh, and so I’d like to get your, [00:36:00] your perspective on. The mental health of young doctors, you know, how have you, how have you seen it change over the years?

Is it getting, is it getting easier to become a doctor? Is it becoming from like a mental health standpoint, uh, or are some of the challenge they’re facing? Challenges that, uh, new doctors face really the same ones we’ve been having for like 30 years. So, I guess when you first started in your current capacity, uh, at Johns Hopkins, were you interacting with a lot of med students and residents?

Dr. Kay Jamison: Sure. Yeah. And, and I would say it’s kind of sorts itself in two ways. One is mental illness. Mm-hmm. Um, which is very real. In house staff and medical students, junior faculty, um, and the other is quote, burnout. So, right. Let me address that separately. In terms of mental illness, it’s always been the case that there’s been, since people started studying [00:37:00] it, that there’s a higher rate of bipolar illness in doctors.

Uh, there’s a much higher rate of suicide. In doctors, particularly in women doctors. Um, and there’s a much higher rate of depression. And so one of the things we tell the medical students at Hopkins is, look, a lot of you’re gonna get depressed. That’s just, that’s just the way it is. I mean, it’s a common illness.

Most common manifestation is your age group. Um, you know, that’s just that, that is, you know, it’s gonna happen to a lot of you. So the question is, what do you do about it? And we will do everything possible to get you well, and we have every reason to believe that we will be able to get you well, but we cannot tolerate impaired doctors.

Um, so, you know, the, you have to make the incentive to reach out for care instead of should curl up in a ball and, and avoid care and mm-hmm. Uh, and also that you keep a wing out for [00:38:00] your fellow classmates. You, you know, what the symptoms are of depression, um, and so forth. So that, that’s just sort of a, a thing.

But, but people do, and people actually in the third year medical school are more likely to get manic because they started their clinical rotations. And there’s sleep deprivation. Mm-hmm. Uh, sleep deprivation is single easiest way. If you’ve got the genes that are gonna gear you toward bipolar illness.

The single easiest way to precipitate mania is sleep deprivation. So people start going on their clinical rotations, stay up all night and so forth. So you make reasonable accommodations and you say, look, uh, if you’re a resident, you’re, you’re gonna have to do the same workload. As your fellow residents, but we’re going to work it around so that you aren’t, you know, being pressured by, by sleep.

Uh, problems and so forth. So I think that there’s more recognition and more of a, an effort to reach out to medical students and health staff. [00:39:00] It’s still pretty quiet, but, you know, I mean, I get a lot of, yeah, because I’ve, as I have been open, people come and say, yeah, how do you negotiate the, the licensing system, the privileges system?

You know, how do you get around this and that? But mainly how do you deal with, with being terrified it’s gonna happen again? You know, you’re talking about your heart problems, you know? Mm-hmm. There’s a certain terror probably lurking mm-hmm. That this is gonna happen again. That’s true for mania. It’s true for breast cancer.

It’s true for so many things. Um, so, so I think just recognizing that mood disorders in particular, anxiety disorder, perhaps less so, but um, Substance abuse, that these are common things in doctors and you know, you could, maybe, you could wish it would be otherwise, but it isn’t. And you know, you’re not gonna have any medical students left if you start saying, you know, can’t have this and you can’t have that.

Right. You know? Right. Or you have pretty boring students. Um, uh, I think, I think burnout’s much more complicated. I mean, the mental illness has been around forever. Right. And it will be, and it’s important to [00:40:00] say this is an illness, it’s not. You know, just putting stress in the background makes everything a little bit more squishy.

Right. Um, with, with burnout, I think that, you know, I mean, you could say that, well, maybe it’s the admissions policy, you know, um, maybe we, we are attracting medical students that are more stress oriented. Are because we, they have these staggeringly high qualifications to get into medical school and we, and weird qualifications.

I find it weird. I was on the admissions committee. I mean, I find it strange that, you know, there’s, I mean, these people are, are, I don’t know where they come from. They’re, they’re brilliant. They’re, they’re accomplished. They’ve all studied with three major cellists and written films and, you know, mm-hmm.

In addition to taking molecular biology majors, I mean, you know, it’s, it’s. These are not normal. These are not the doctors of, of your right? Mm-hmm. Okay. So these are, [00:41:00] these are, and I think there’s something to be said. Obviously for that group of people, but also for the doctors of your who may have been a little bit more matic, a little bit more, taking things as as they come.

Um, I think another thing is, is the system’s just insane in terms of Epic and, uh, medical records and, and. Putting those expectations and taking away some of the delights of practicing medicine that used to be there. Um, and I think that that’s something that’s, that’s a real problem. And, and whether you call it burnout or depression is also another issue because I, yeah.

You know, a lot of what gets called burnout is a discontent and is to a certain extent, encouraged by the system because everybody talks about burnout all the time, right? Mm-hmm. Right. And everybody, they do perhaps less to ameliorate. Burnout than they do to just put it out there, that people are, there’s almost a weakness, quality to it that you know that, that you’ve burned out.

Mm-hmm. Mm-hmm. [00:42:00] Um, so I, I, so I think that that’s, uh, you know, I think we should take it instead of just talking about burnout, that we should also talk about depression and, but we should also talk about a system that encourages endless discussion at burnout, uh, as opposed to, I mean, I sometimes talk to young doctors and I think, you know, yeah, I can understand this is stressful, but, you know, try being a secretary who doesn’t have any money, doesn’t have a job she likes, um, you know, and so forth.

That, that’s, that’s, that’s real stress. Um, you know, it’s the people at community colleges, if you talk to students in community colleges mm-hmm. As opposed to the Ivy League. Ivy League has a very special kind of stress. But boy, these kids that are working 50 hours a week, And are the first kids in their family to go to college.

That’s, you know, that’s, that’s a different kind of stress, 

Kristin: right? It affects your life in a whole different way. How do you think the right pandemic factors in, do you [00:43:00] think? You know, in that case now there’s, there’s a bunch of. You know, vicarious trauma and, uh, maybe some moral injury happening, um, among doctors, right?

As you’re treating these people and, and there’s only so much you can do, or you’re being prevented from being what you know they need from doing what you know they need. Has that exacerbated burnout and in a real way, 

Will: or uncovered more mental 

Dr. Kay Jamison: illness? Yeah, or I would say, I mean, I’ve, I, I, I think with nurses particularly mm-hmm.

Who were there, you know, Hour in, hour out, hour in, hour out, uh, that, that you can just see it in the, in the resignation rates. You know, I mean, it is, it’s just really deeply upsetting to see that. And the question is, how do I think, how do all of us reach out to follow professionals? And, you know, say we can try and understand what you’ve been through.

What can we do to make a difference? [00:44:00] Um mm-hmm. I think that’s true for doctors, but, but less so. I think doctors had more independence in it. Mm-hmm. Um, and is so they, I I, I know that one of the things that, um, the, our chief of nursing was giving a talk, a great talk not too long ago, and she said, you know what I will never, ever do again in the rest of my life is keep a dying patient.

Away from a family member. Yes. You know, because of Covid protocols, you know, you can help you learn from things. That’s, that’s all. Mm-hmm. I think is that you can say you can learn, but you also can expect that people will recover. Because I think if you play to people’s weaknesses and fears and anxieties all the time, um, you perhaps encourage some of it.

And if you say it’s been really difficult, it’s been really hard, uh, but. You’ll get through it. We’ll all get through it, and yeah, people are actually getting through it. Um mm-hmm. 

Kristin: Yeah, maybe a little more, a little more, [00:45:00] um, you know, concentration on how to deal with those things when they happen. Right? So first awareness, and I think that’s what’s gotten, you know, better may, depending on how you look at it, it’s gotten more prevalent, um, is just awareness of these issues and talking about the issues.

Um, but it’s like you’re mentioning, it’s no good to just sit and wallow in those. Feelings. We need to be preparing people and equipping people to do something about it, to, you know, get out of that place. 

Dr. Kay Jamison: Yeah. Giving people positive things to do as a pro. Again, playing to people’s strengths as opposed to Yeah.

Playing always to, this is, this is the end of the world. It’s not the end of the world. It’s a bad epidemic and it has been. Cost a million lives, and there’s been incompetence and, you know, mistakes and, and terrible things, and it’s driven this country apart in a horrible, horrible, [00:46:00] unforgivable sort of way.

But the emphasis has to be on how do you heal that? Um, and how, how do you mm-hmm. Get around that horribleness. 

Will: And that’s, that’s something that you, um, as far as. How to heal, uh, uh, from a mental health, mental illness standpoint. Something you touch on a lot in your new book. So I’d like to talk about that.

Uh, your book called Fires in the Dark, healing The Unquiet Mind. Uh, I think it’s coming out in May. Uh, just a, a short time from now. Well, so 

Kristin: by the time this airs, it will be out. Oh, yes. Yes. So we encourage everybody to go 

Will: check that out. Absolutely. Uh, and so can you give us a little bit of, uh, background of this book and, and why you wrote it and, and what people can look for?

Dr. Kay Jamison: Um, I wrote it as kind of a love song to psychotherapy, but in a very general sense. I was interested, I. What, what can we do? What do we do? What do doctors do? What do priests do? What do we do, uh, [00:47:00] about psychological suffering? And I was interested in tracing it way back in time to thousands and thousands of years indeed, back to the Neanderthals, to seeing what people did.

Uh, when they were in mental pain. Interesting. And through the, uh, war fields and the doctors who had to deal with trauma and had to improvise on the spot for hundreds of thousands of, of soldiers with, uh, shell shock in the first world war, uh, to, to monotherapy and to the combinations of therapy and medication, but also the use of the arts.

I was, I was very interested in always beholden to. People, everything from King Arthur to Paul Robeson. And I wrote about, uh, lives of courage and, and beauty and how we have to build our own islands in order to survive. And it’s up to us to build the islands, but it’s the help of [00:48:00] doctors and, and friends and family that, uh, make it possible.

Will: Well, it’s, it’s super interesting. Yeah. Fascinating, uh, subject for a book. I, I love, you know, medical history and seeing how things have changed over time and it’s, yeah. I guess, 

Kristin: and I think maybe sometimes along the way we lose some wisdom that, you know, maybe if we revisit we can, we can gain some of that.

Back again in a new, modern way. 

Will: Yeah, exactly. Well, uh, Dr. Jameson, thank you so much for joining us. It’s really been a pleasure to talk with you. And again, um, that book is Fires in the Dark, healing the Unquiet Mind. And I think you’re also, you can find information about you on, uh, your Facebook page, uh, Kay Redfield Jameson.

Uh, and, um, just, uh, again, thank you so much. Uh, we really appreciate your time. 

Dr. Kay Jamison: It was delightful to talk to. You got a great program. Thanks. Thanks so much. Oh, thank you. Thank you so much. 

Will: Take care.[00:49:00] 

Okay, let’s take a look at some of our favorite medical stories that were sent in by the listeners. It’s fan story time. Yay. Uh, here we go. So we have Patricia. Patricia says, recently I’ve had a Prime lesson on. Never assume patients know how to take their medicine, even if they’ve been prescribed it, um, multiple times.

That’s, that’s a good, that’s a good little lesson there. So a patient came in, handed me their prescription, and it was for some suppositories, it’s pretty common. Even adults are prescribed those, especially when dealing with upper GI tract problems. I had, I had them in stock. Got the package and was about to hand them to the patient.

When they asked for ones from a different manufacturer, I told them I would have to order a different generic, but asked what the problem with this specific brand was because I wasn’t sure if it would make a whole lot of difference. The patient then asked me to look for ones that didn’t contain paraffin.

I was growing confused at this point, paraffin. The wax. The wax, right? [00:50:00] Yeah. Because, and I quote, I’ve been prescribed these before and they taste so waxy. Oh dear. Oh dear. I absolutely did not recover in time to stop myself from asking them. Uh, but how would you be able to taste them when you apply them through your.

You know, after which I was treated to the most stunning color show on their face going from white to red. I guess that’s when the realization kicked in. Well, they asked me to hand their prescription back before they could say anything. I bolted. Uh, they bolted out of the pharmacy. See, so maybe this could be a PSA for all doctors and pharmacists the world over.

Please don’t assume patients know where their suppositories go 

Kristin: and. In this patient’s defense? Yep. It sounds to me as though no one explained it to her. Well, is it her? Him? Do we know? We don’t know. They’re them. Them. No one explained it to them well enough. Clearly. 

Will: Well, I think the last all and certainly, you know, don’t [00:51:00] hesitate to explain things multiple times.

Yeah. Check for understanding. Of course. Yeah, yeah, yeah. It’s a, it’s a good lesson to learn, but also quite a story that poor, that poor patient. 

Kristin: I mean, it can’t hurt you to swallow it, right. It’s going in the same place eventually. 

Will: I have honestly no idea what, what. The outcome of that. That’s probably something I should have been taught at some point in med school.

Yeah. What, and 

Kristin: it’s just the other end of the, the same tube. 

Will: So consume orally, uh, a suppository. It is the same. It’s a tube, right? Yeah. 

Kristin: Yeah. I mean, stomach acid’s gonna do some things to it, but also that might be, so with the intestines, well, 

Will: well, not quite as, not quite to the extent, not harshly, I guess, but of the stomach acid.

But you know, I like where you’re thinking. Yeah. You know, your head’s in the right place, um, at the top of the tube. And so we got fan story number two, uh, from Misty. Misty says, in my intern year of pediatrics, I was doing my nursery rotation. One night, a fellow intern and I got a call from the nursery [00:52:00] because a newborn had a fever.

I. This requires an evaluation for infection, including procedures, and we had to get permission from the family first. Then the nurse told us that the mother only spoke Spanish. This was well before translators were readily available in our hospital. My fellow intern had some Spanish knowledge and volunteered to communicate the situation.

Unfortunately, she knew conversational Spanish and not medical Spanish. She told the mother that the baby was fumar. Oh no, you, you do know Spanish. Kristen here is a Spanish major in college, so she’s, I remember 

Kristin: some of it. Conversational 

Will: Spanish. Yeah. While she thought this would translate into hot or febrile, she actually told the mother that the baby was smoking 

Kristin: barbecue.

Is that right? The baby? Yes. That’s Fumar smoking. Yeah. Whoops.

Your baby is smoking. Ma’am, I’m sorry to tell 

Will: you. The, the mother, what’s the correct 

Kristin: word? Well see, I don’t know. Medical, this is the whole [00:53:00] point. Fever. I don’t know what it would be. Okay. When it comes to, yeah. Fever, Kellye. Um, again, that’s gonna be a different meaning than you want. Gotcha. I think else babies are definitely the.

That word does not apply to that. I’ll go ahead 

Will: and stop there. Um, okay. The mother was truly surprised to hear 

Kristin: I would, I would guess kalo. Like kalo? Yeah. Kalo was heat. Oh, okay. Okay. 

Will: But I don’t know. That’s a guess. Yeah. You guys let us know. I’m sure we don’t. Other people who actually know like medical Spanish, uh, the mother was truly surprised to hear that a baby had picked up smoking on her second day of life for fortunately.

We found nursing staff who spoke Spanish and they were able to correct the misunderstanding. We joked about it for years afterward. Uh, that’s hilarious. That’s a good one. 

Kristin: That’s a really good one. Fumar. See, it’s funny, I don’t know why, but my mind didn’t go to smoking like a cigarette. It went to your baby’s on fire, smoking.

Will: Oh, that was good. Send us your stories. Knock-knock [00:54:00]

That was, oh, that was a fun 

Kristin: episode. Yeah. Really fascinating, 

Will: man. Talk about experience. Yeah. Like it’s 

Kristin: professional, personal. Yes. Everything, 

Will: uh, Dr. K Jameson, just, uh, the, the wealth of knowledge he has on this topic and having also just. Been in this field for so long and seeing the changes over time, uh, and the, the reaction to, to mental illness and mental health, um, and how that’s, that’s changed.

Kristin: Uh, she brought up a good point too of, you know me. Yes, it’s good that mental health is in the conversation more, um, today, but you don’t wanna forget that mental illness is its own thing within that it needs different, that’s true things than just, you know, Keeping yourself healthy, just the same way that a, you know, physical health differs from disease mm-hmm.

Per se. So I thought that was a nice distinction to keep in mind as we [00:55:00] continue these discussions. And that’s true. 

Will: Cause I, I never, I mean, I, I talk about burnout a lot and mm-hmm. And I do a little bit on mental health in my videos, but, uh, I, I’ve never really thought about it that way, like, Right. We 

Kristin: sometimes there is an illness happening Yeah.

That needs a different kind of treatment. 

Will: Right. And, and, and we need to talk about that in particular. Right. So, uh, lots of, lots of good, uh, things to, to think about and just a very, also very timely topic. Yeah. You know, so thank you Dr. Jameson for joining us. Uh, and, uh, thank you all for listening. Do you have any, i any thoughts about the episode?

We’d love to hear what you guys think, uh, about anything from, you know, mental illness, uh, our conversations on that. Or about, uh, uh, smoking babies. Uh, if you have any thoughts about smoking babies, we’d love to hear babies on the barbecue. There’s lots of ways to hit us up. Email us, knock nachi human

Uh, visit us on our social media platforms. We’re on pretty much all 


Kristin: them. We’re gonna try to provide some value across the board. [00:56:00] 

Will: I am, I am frequently impersonated on social media and so it was suggested by you Yes. To that. We have a presence everywhere. Uh, so that I don’t get my identity from No one cares.

Okay. Alright, let’s, let’s move on. Let’s move on. Uh, also hang out with us in our Human Content Podcast Family on Instagram and TikTok at Human Content Pods. I forget that we’re actually like, people are listening. People listening. They want us to, everything we’re saying. Thank you to all the great listeners leaving awesome feedback and reviews.

If you subscribe and comment on your favorite podcasting app or on YouTube, we can give you a shout out like right now. Uh, at Jennifer Ellsworth 1226 on YouTube said, Dr. Glock and Flecking. Jonathan always has the perfect words. Look to Jonathan. I agree. Head nod to you. All right. Keep sending us all those, all, all your, uh, reviews and jokes and guest ideas.

We love, we love hearing that stuff, uh, and stories. Lots of stories. Uh, we also, these episodes are up on YouTube [00:57:00] every week on my channel at d Glock Flecking. We also have a Patreon. Lots of cool perks, bonus episodes. We are there and interacting with you guys. Early ad free episode, access, interactive q and a livestream events.

Much more. I like 

Dr. Kay Jamison: to pose 

Kristin: pictures where you look 

Will: silly. Yes. She, uh, she, she, we, we get it. We give you a lot of, uh, well, behind the scenes. Behind the scenes stuff. Mm-hmm. Yeah. To see like what, uh, this weird life is like. Uh, or go to Glock and Speaking of Patreon, community Perks, new member, shout out to Juliet B.

Thank you, Juliet. Welcome. And shout out to, of course, to all the Jonathans head nod to you all. Patrick, Brianna, l Edward, K, Caitlin, C, KLS, Lucia, C Mary, H, miss Granddaddy Omer, Steven G, Jonathan a W, Jonathan, f Leah, Marion, w Mark, Robox, and Sharon, s Patreon, roulette time. Drum roll please. Shout out to Chr [00:58:00] W for being a patron patriot.

I like that you ask 

Kristin: yourself for a drum roll. Oh, yeah. 

Will: Hey, hey. Don’t random. My parade here. That’s my my favorite part of doing this. I said, I like it. Not really though. We’re your hosts, will and Kristen Flannery, also known as the Glock Flecking. Special thanks to our guest today, Dr. K Jameson. Our executive producers Will Flannery Kristin Flannery, Aron Korney Rob Goldman, and Shahnti Brooke, our editor and engineer Jason Portis.

Our music is by Omer Ben-Zvi. To learn about our night knock highs program, disclaimer, ethics, policy submission verification, licensing terms, and HIPAA release terms, you can go to clock and and reach out to us. Knock knock with any questions, concerns, or jokes. Knock Knock High is a human content production.[00:59:00]