Podcast Summary: Divergent Conversations

Episode 137: FLASHBACK — Autistic Burnout City: Perpetual Sensory Hell

Hosts: Dr. Megan Anna Neff & Patrick Casale
Release Date: December 19, 2025

Episode Overview

This episode kicks off a new series on Autistic Burnout. Megan (Dr. Neff) and Patrick, both autistic-ADHD (AuDHD) clinicians, get candid about their ongoing experiences with burnout, differences between burnout and depression, and how sensory overload shapes their lives. With humor and vulnerability, they imagine “Burnout City”—a metaphorical sensory hell—and reflect on personal and clinical challenges navigating burnout as neurodivergent professionals. The episode offers insights, relatable anecdotes, and sets up the forthcoming series on burnout recovery.

Key Discussion Points & Insights

1. Life in Autistic Burnout: A Perpetual State

• Opening Reflection: Both hosts question if they ever really leave burnout.
  • Patrick admits:

    “Yeah, I mean my life does feel like perpetual burnout. Yeah, it really does.”
    — Patrick (02:59)

• Sensory Overwhelm as the Core Distinction:
  • Patrick describes the visceral feeling of autistic burnout as “an exposed nerve ending, moving through the world, being shocked all the time” (05:27).
  • For Patrick, a major difference between burnout and depression is total system overwhelm—mentally and physically—with irritability and withdrawal.
• Burnout Symptoms Identified:
  • Sensory meltdowns/shutdowns increase (07:02)
  • Routine social and work tasks feeling like “molasses” (06:40)
  • Loss of interest in special interests, isolation, and increased frustration
  • Understimulation (loss of curiosity, difficulty with creative pursuits) pairs with overstimulation

2. The “Burnout City” Metaphor

• Building Burnout City:
  • The hosts inventively imagine a city representing autistic burnout:
    • Only Applebee’s to eat (08:19)
    • Scratchy wool clothes, socks that irritate (08:53)
    • Ambient laundry exhaust with overpowering chemical smells (09:02)
    • Only vehicles: siren-blaring ambulances and fire trucks (09:22)
    • Under/overstimulation: “You’re either wanting to crawl out of your skin or you’re so overstimulated you’re curled up in a ball and you just can’t get out of it.” — Patrick (09:53)
    • Beds made of plywood and lumpy pillows, endless waiting at accommodation centers (29:07; 29:41)
    • Only barky dogs and sickly cats for pets (28:07-28:49)
• Humorous Take: This metaphor lightens the discussion but drives home the relentless, overwhelming, and “no-win” nature of autistic burnout.

3. Burnout vs. Depression & Chronic Health

• Linking Current and Past Health:
  • Megan shares her experience with chronic illness (long Covid, asthma) and questions diagnostic overlap:

    “Do I call that autistic burnout? Do I call that long Covid? Chronic fatigue syndrome?” (15:20)

  • Both hosts note how chronic pain/illness act as major triggers and complicators for autistic burnout (33:40-34:01).
• Burnout Leading to Depression:
  • Megan explains how burnout saps curiosity and energy, which can tip into depression (10:06-11:13).

4. Sensory & Seasonal Cycles

• Summer Isn’t a Cure-All:
  • Despite increased sunlight, Patrick finds heat and environmental overstimulation exhausting (12:49-14:56).
  • Sensory stress, hypervigilance, and the cognitive load in maintaining equilibrium remain year-round.

5. Burnout, Misalignment & Work

• Values Alignment & Work:
  • Patrick discusses how doing work he’s not passionate about amplifies his burnout (23:43).
  • The tension between capitalism’s demands and neurodivergent needs for rest and alignment is palpable.

    “Once the passion went away, it really didn’t feel. It [work] feel very misaligned... and that just almost amplifies everything.” — Patrick (24:46)

  • Megan and Patrick both need their “bodies to say hell no” before stepping back (26:22).

6. Burnout and Compulsivity (OCD/ADHD Overlap)

• Compulsions Increase with Burnout:
  • Megan asks if burnout impacts Patrick’s OCD/compulsive checking, cleanliness, etc.
  • He notes that while the urge increases, he often lacks energy to actually follow through on compulsions (37:49-40:14).
  • Megan: “It’s almost like I have less control over my checking behavior” when burnt out (39:46).

7. Difficulty Identifying Burnout (Alexithymia & Interoception)

• Late Realization:
  • Many, especially those with poor interoceptive awareness, don’t realize burnout until “they’ve hit the bricks” (42:00).
  • Focusing on external markers (e.g., safe food routines, sensory avoidance, social withdrawal) can help identify early burnout signs (43:12-43:42).

8. Burnout as a Catalyst for Diagnosis

• Discovery Through Burnout:
  • Many adults discover their autism in the context of profound burnout, when masking fails and coping tools collapse (44:48-45:25).
  • This period is especially vulnerable, demanding compassion and support from professionals.

Notable Quotes & Memorable Moments

• On Differentiating Burnout from Depression:

  “I really start to think about the sensory component... Like I’ve talked about this before: that exposed nerve ending, moving through the world, being shocked all the time. That feels constant.”
  — Patrick (05:27)

• On Understimulation and Curiosity:

  “When I lose access to curiosity, that to me becomes a trigger for depression. Partly, so for me, burnout will often lead to depression, but it's that under stimulation—nothing sounds good... I don’t have energy.”
  — Dr. Neff (10:06)

• On Burnout City:

  “If Burnout was a city... The only vehicles that exist are ambulances and fire trucks with their sirens on... it’s like the ice cream man, but that thing is just blaring all the time.”
  — Patrick (09:22)

• On Work Misalignment:

  “Once the passion went away, it really didn’t feel... it felt very misaligned. And then like, obviously continuing to show up in those spaces... because capitalism and needing to make money... that just almost amplifies everything too.”
  — Patrick (24:46)

• On Multi-Systemic Burnout:

  “With autistic burnout, it’s multi-systemic... your nervous system’s probably been dysregulated for a long time... there’s a lifestyle factor, there’s just... it’s a multiple system thing. And then of course, if we’re having any mental health condition on top of that or medical condition... those are also some drivers for burnout.”
  — Dr. Neff (31:05)

• On Burnout Leading to Diagnosis:

  “This is when we start to see a lot of people discovering they're autistic later in life: when you’ve hit such intense periods of autistic burnout that something has to give.”
  — Patrick (44:03)

• On Universality but Uniqueness of Autistic Burnout:

  “All humans probably in modern society are experiencing some level of burnout. And it’s not the same. It’s not the same as autistic burnout.”
  — Dr. Neff (34:01)

Timestamps for Important Segments

• Defining Autistic Burnout vs. Depression:
  • 03:36 – 06:40
• Burnout City Metaphor and Sensory Hell:
  • 07:29 – 10:06 | 28:07 – 30:18
• Creativity, Curiosity, and Understimulation:
  • 10:06 – 11:40
• Burnout and Work, Misalignment:
  • 23:43 – 26:28
• Health, Chronic Illness as Burnout Triggers:
  • 15:20 – 19:33 | 33:40 – 34:01
• OCD/Compulsivity and Burnout:
  • 37:12 – 40:14
• Markers & Early Warning Signs:
  • 42:00 – 43:42
• Burnout as Catalyst for Autistic Discovery:
  • 44:03 – 45:25

Takeaways & Clinical Insights

• Burnout is multi-dimensional and often chronic for AuDHD adults, entangling with depression, sensory overload, and chronic illness.
• Sensory distress—both over- and under-stimulation—sits at the core of autistic burnout.
• Misalignment in values and work intensifies burnout; finding or building alignment can be an essential recovery tool.
• Many discover their autistic identity in the context of major burnout, which can be both illuminating and destabilizing.
• Burnout recovery requires recognizing personal patterns and external cues, as internal awareness is often delayed due to alexithymia/interoception differences.

Next Episode Preview

• A deeper dive on “building a burnout recovery plan” and practical strategies for everyday life.

Resources Mentioned

• Neurodivergent Insights Autistic Burnout Resources — curated free & paid resources, articles, workbooks, and upcoming email course.
• Previous podcast deep-dive episodes:
  • Episode 2: Full exploration on autistic burnout
  • Episode 47: Further deep-dive

Tone and Language:
Conversational, candid, humorous, and deeply validating, with a healthy dose of clinical reflection and self-deprecation.

For more on burnout, lived neurodivergent experience, and affirming practice, follow @divergentconversations on Instagram or visit divergentpod.com.