Podcast Summary: Divergent Conversations, Episode 126 (Season 4)

"Am I Still Me? Post-Diagnosis Identity Spiral"

Hosts: Dr. Megan Anna Neff & Patrick Casale
Release Date: October 3, 2025

Episode Overview

In this raw and affirming episode, Dr. Megan Neff and Patrick Casale, both neurodivergent clinicians, explore the profound identity upheaval experienced after an autism or ADHD diagnosis (often in adulthood). They candidly discuss the internal spiraling that can follow—unraveling old assumptions, facing imposter syndrome, grappling with intersectional identities, and negotiating new accommodations and relationships. The pair share their lived experiences, highlight the whirlwind of self-questioning that arises, and reflect on the destabilizing yet eventually stabilizing journey of integrating a neurodivergent identity.

Key Discussion Points & Insights

1. The “Am I Still Me?” Question – Identity Spiral After Diagnosis

[01:47-03:26]

• Dr. Neff introduces the central theme: post-diagnosis identity spiral, summarizing it as: “Am I still me?”
• Patrick relates deeply, sharing that unmasking led him to question everything from friendships to hobbies to core values:

  “You start to question your sense of self completely... When all is said and done, you’re left kind of sorting through almost like an archaeologist: is this me?” (Patrick, 02:21)

2. “Buckets” of Identity Upheaval

[03:01-06:35]

• Dr. Neff describes several “buckets” (categories) in which identity questions arise:
  1. Masking Bucket: Realizing that long-term masking has disconnected individuals from their authentic desires and pleasures.
  2. Diagnosis Bucket: Wondering if naming a trait (e.g., “special interests” as “autistic traits”) reduces its significance as part of one’s personality.

     “If it’s an autistic trait, does that make it less of a personality thing?” (Dr. Neff, 03:26)

  3. Imposter Syndrome: Doubting the validity of one’s diagnosis and feelings of not being “autistic enough” or “ADHD enough.”

     “What if all this time I’ve spent... trying to figure this out... chalks up to ‘nope’, otherwise specified?” (Patrick, 05:05)

3. Intersecting/Queering Identities

[06:46-07:41]

• Embracing a new neurodivergent identity often leads to re-examining other facets of self (race, gender, queerness, etc.).

  “Whenever you start queering any one identity... all other identities often get put on the table.” (Dr. Neff, 06:46)

• Integration of neurodivergence expands into questioning broader social constructs and initiating self-discovery in multiple domains.

4. Accommodations, Vulnerability, and Shame

[07:41-09:25]

• Becoming aware of one’s needs and accommodations can cause shame, especially from previously cultivated hyper-independence.

  “If part of our identity before was maybe being hyper achieving or hyper independent... that identity is threatened.” (Dr. Neff, 08:15)

• The process sometimes triggers ableist responses from others about “needing more” than before.

5. Shifting Relationships, Careers, and External Validation

[09:25-10:49]

• Diagnosis and disclosure often prompt dramatic changes in friendships, partnerships, and professional paths.

  “Friendship/relationship bucket gets created: who do I feel is affirming and understanding, or at least curious enough to learn?” (Patrick, 08:47)

• Careers may shift, as one’s capacity and interests realign.

6. Community Engagement – “Burnout City” & “Monotropic Manor” Art Projects

[10:12-11:11]

• The hosts brainstorm a collective art project about autistic burnout (“Burnout City”) and monotropic focus (“Monotropic Manor”).

  “If anyone’s listening, and you like doing art, send in your pictures of Burnout City or Monotropic Manor...” (Dr. Neff, 10:18)

• Community call: Listeners are invited to submit illustrations via Instagram or email.

7. Overwhelm & Continual Self-Doubt

[11:21-14:53]

• The process feels like “the roof is leaking”—so many “buckets” of challenge, not all in one’s control.

  “All these buckets are piling up, and it almost feels like the roof is leaking and it’s falling into all these different places, appropriately though.” (Patrick, 11:13)

• Constant questioning: “Am I actually autistic/ADHD?” and a drive to “map” every experience to a diagnosis (sometimes to a fault).

  “There can be this urge to try and pinpoint every single experience we have to a diagnosis... sometimes we start losing our humanity.” (Dr. Neff, 12:53)

• The “complex soup”: Co-occurrence of autism/ADHD with trauma, OCD, bipolar, etc. makes mapping even more confusing.

8. Disclosure – Deciding Who to Tell and Managing Vulnerability

[15:39-16:30]

• Disclosure is complicated; fear of being disbelieved or having to “prove” struggles.

  “Do I have to unpack my trauma or the things I feel shame on for you to believe this thing?” (Dr. Neff, 16:08)

• Many choose just one or two “safe people” to initially confide in.

9. Destabilization Before Restabilization

[20:45-23:40]

• Both hosts detail the destabilizing first year after diagnosis, especially while managing other major life events (e.g. Patrick’s major throat surgery/losing his voice; Megan’s long Covid and pandemic parenting).

  “For me, it was more stabilizing, but I’ve definitely seen for some people it really is more destabilizing... coming to this identity.” (Dr. Neff, 20:45)

• Overlapping crises can “overshadow” or convolute the identity process.

10. Why Is It So Heavy? Reflections on Playfulness

[24:35-28:13]

• The duo reflect on why recent episodes feel heavier, less playful than the previous “Burnout City” series.
• Possible explanations: the personal nature of identity work, the heaviness of listener-submitted questions, and the sheer number of episodes recorded in a short time.

11. Vulnerability of Sharing

[28:13-28:31]

• Dr. Neff anticipates feeling greater vulnerability when these identity-focused episodes air, as opposed to previous clinical/educational topics.

Notable Quotes & Memorable Moments

• On Unmasking:

  “Masking separates you from your true sense of self so much... you’re left kind of sorting through almost like an archaeologist.”
  — Patrick Cassell (02:21)

• On Imposter Syndrome:

  “What if I am not autistic/ADHD? What if all this time I’ve spent... trying to figure this out... chalks up to ‘nope’, otherwise specified?”
  — Patrick Cassell (05:05)

• Naming Traits & Identity:

  “If it’s an autistic trait, does that make it less of a personality thing?”
  — Dr. Neff (03:26)

• Diagnosis and Relationships:

  “Who am I placing in this bucket? Who I feel is affirming and understanding or at least curious enough to learn?”
  — Patrick Cassell (08:47)

• On Vulnerability in Disclosure:

  “Do I have to unpack my trauma or the things I feel shame on for you to believe this thing?”
  — Dr. Neff (16:08)

• Destabilizing Process:

  “I was discovering this early in the pandemic...grappling with long Covid, autism, working remote, parenting... overlapped in ways... I almost diagnostically overshadowed, saying everything was the autism...”
  — Dr. Neff (22:23)

Important Timestamps

| Timestamp | Segment/Topic | |-----------|-------------------------------------------------------------| | 01:47 | Introduction of “Am I Still Me?” question | | 02:21 | Unmasking and existential questioning | | 03:01 | Buckets of identity — masking, diagnosis, imposter syndrome | | 06:46 | Intersectional/queering identity | | 07:41 | Accommodations, vulnerability, shame | | 08:47 | Relationship shifts | | 10:12 | Community art project idea | | 11:13 | “Leaking roof” metaphor for identity buckets | | 12:53 | Over-mapping to diagnoses | | 15:39 | Disclosure and vulnerability | | 20:45 | Destabilizing vs. stabilizing integration | | 22:23 | Megan’s pandemic/health context | | 24:35 | Struggling to find playfulness in heavy topics | | 28:13 | Anticipating vulnerability as these episodes air |

Tone & Language

• Conversational, vulnerable, and affirming
• Candid humor: Acknowledgment of chaos, heaviness, and creative tangents
• Maintains clinical insight while foregrounding lived experience

Summary Takeaways

This episode thoughtfully maps out the turbulent territory of post-diagnosis self-discovery for neurodivergent adults. Dr. Neff and Patrick Casale dissect the many “buckets” of identity—masking, impostor syndrome, intersectionality, accommodations, relationships—and capture the sense of uncertainty, grief, and eventual re-calibration this path demands. Listeners hear that destabilization is both common and necessary; that neurodivergent identity is complex and multifaceted; and that seeking community, permission to question, and safe spaces are vital steps toward integration.

Listener Invitation:
Share your illustrative visions of “Burnout City” or “Monotropic Manor” via Instagram or email to join in collective reflection and art-making.

For more resources, visit:
neurodivergentinsights.com/burnoutresources