Divergent Conversations – Episode 77

OCD (Part 3): Differentiating OCD, Autism, and Tourettes Behaviors and Enhancing Healthcare
Featuring Dr. Stacy Greeter
Release Date: October 25, 2024

Episode Overview

In this engaging and deeply affirming episode, Dr. Megan Anna Neff and Patrick Casale are joined by Dr. Stacy Greeter—an openly autistic, ADHD, and OCD psychiatrist based in Florida—for the third part of their OCD series. The trio dives into the nuanced, often misunderstood differences between OCD, autism, and Tourette's, using accessible metaphors and playful psychoeducational storytelling. They also discuss challenges for neurodivergent individuals navigating healthcare, the importance of self-advocacy, and the value of authenticity and playfulness in clinical work.

Key Discussion Points and Insights

1. Introduction to Dr. Stacy Greeter and Psychoeducational Storytelling

• Dr. Greeter’s Approach:

  • Stacy introduces her special interest in psychiatry and a passion for using fantasy creatures (like dragons and Star Wars characters) to explain psychiatric concepts, especially to children but also adults.
  • She describes her “psychoeducational fanfiction” presentations, such as a Little Mermaid-themed talk on neurodivergence and a Lord of the Rings-themed discussion about OCD using the character Smaug.

• Quote:

  “My autistic special interest is everything psychiatry... and my other other autistic special are fantasy creatures, especially the fluffy ones.”
  —Dr. Stacy Greeter [01:27]

• Memorable Example:

  • Little Mermaid presentation titled “Still Not Quite Part of Your World,” explores the intersection of autism and ADHD through Ariel’s story.

2. Storytelling as a Tool for Processing and Connection

• Discussion:

  • Megan praises the narrative, playful approach, noting its resonance for neurodivergent individuals. They reflect on playfulness as an important, often repressed, facet for autistic and ADHD people.

• Quote:

  “It makes it so much more playful, so much more accessible.”
  —Dr. Neff [05:13]

3. Differentiating OCD, Special Interests (Autism), and Tics (Tourette’s)

• Key Insight:

  • The same behavior (e.g., organizing Pokémon cards) can have very different internal motivations—compulsion vs. joy.
    • OCD: Fear-driven, ego-dystonic, accompanied by distress and urge to stop but cannot.
    • Special Interest (Autism): Joyful, self-soothing, ego-syntonic, experienced as pleasurable.
    • Tics (Tourette’s): Sensory/physical urge that builds over time if not performed.

• Quote:

  “...with the OCD, the urge... is based on fear. The urge to do the behavior is based on fear and it dissipates the longer you resist it. With the tic, it’s more of a sensory, physical urge that will build the longer they resist the behavior.”
  —Dr. Stacy Greeter [11:04]

• Memorable Segment:

  • [09:00–11:30] — Detailed breakdown of how clinicians can differentiate between these behaviors by inquiring about the person’s experience and motivation.

4. Navigating Overlapping and Intertwined OCD and Autism

• Complex Presentations:

  • Discussion about how OCD can “contaminate” special interests or value-driven behaviors, resulting in messy, hard-to-treat cases.
  • Dr. Neff shares a poignant example involving her child’s veganism and OCD intersecting.

• Quote:

  “That’s a whole different beast because they’re intertangled... It’s often messy. The same behavior can have multiple, multiple layers to it.”
  —Dr. Stacy Greeter [13:28]

• Clinical Tip:

  • Stacy uses values-driven interventions, asking clients to imagine what behaviors would look like if not driven by OCD—to reclaim the parts aligned with their identity and values.

5. The Ongoing Internal Dialogue: Is This OCD or Me?

• Core Struggle:

  • Constantly doubting whether a thought or behavior is compulsive or authentic is draining and often unresolvable—contributing to autistic burnout.

• Quote:

  “We have to make lots and lots and lots of peace with ambiguity.”
  —Dr. Stacy Greeter [22:05]

• Memorable Dialogue:

  • [19:06–23:00] — Insightful reflections about therapists with OCD, the labor of teasing apart obsessions from values, and the “fantasy” of a neurotypical reference mind.

6. Medical Culture, Burnout, and Advocacy for Neurodivergent Doctors

• Challenges for Neurodivergent Clinicians:

  • Medicine selects for autistic traits, but being openly autistic in medical environments is risky and stigmatized.
  • Dr. Greeter is developing resources/presentations for supporting autistic doctors, especially during medical training.

• Quote:

  “My favorite part of discovering I was autistic was being able to tell my patients and just seeing that glow of connection and excitement and some hope...”
  —Dr. Stacy Greeter [25:03]

• Systemic Barriers:

  • Medical training teaches avoidance of vulnerability and error, making it hard for doctors to admit uncertainty; this especially impacts the care of complex, neurodivergent patients.
  • Autistic doctors may connect well with patients but struggle with hierarchical relationships with colleagues.

7. Navigating the Medical System as a Neurodivergent Patient

• Advice and Resources:

  • Dr. Greeter has developed a document, “How to Win at Being a Psychiatric Patient,” with scripts and clarifications of the patient/doctor relationship.
  • Sometimes masking in appointments is survival—focus on getting needs met, not being “right.”

• Quote:

  “Walk into the appointment not wanting to be right, but just getting your needs met... sometimes, like, masking is a survival response.”
  —Dr. Stacy Greeter [34:47] and Dr. Neff

• Tips:

  • Prepare written notes and questions
  • Bring an ally if possible
  • Schedule more frequent, shorter appointments
  • Vent to a safe person after challenging visits

8. Concrete Tools for Differentiation: Charts, Venn Diagrams, and Playfulness

• Resources:

  • Stacy shares colorful charts (available on her website) capturing differences between stimming, tics, and OCD compulsions—timelines, internal experiences, treatment nuances.

• Visual Engagement:

  “I have a chart on treatment differences too, which is why it’s so important to distinguish them...”
  —Dr. Stacy Greeter [39:44]

• Role of Play in Therapy:

  • The group reflects on how embracing playfulness and authenticity improves connection and outcomes, and helps neurodivergent clients feel safe and welcome.

• Quote:

  “The more I can move into a freer, vulnerable, more playful, authentically autistic self, the better psychiatrist I am.”
  —Dr. Stacy Greeter [43:07]

• Discussion:

  • “Play shame” as a form of internalized ableism; reclaiming play is key to unmasking for many neurodivergent people.

9. Autistic Representation, Referrals, and Long-Term Vision

• Current Efforts:

  • Stacy maintains a spreadsheet for autistic (and otherwise neurodivergent) doctors, therapists, and assessors willing to be public about their neurotype—“people really, really, really want to connect with you and your autistic self.”
  • Need for more directories for autistic professionals of all kinds, which would reduce labor and enhance accessible care.

• Quote:

  “Studies show that if you are an autistic doctor and you have worked with another doctor you believe is autistic, your rate of suicide is lower.”
  —Dr. Stacy Greeter [52:22]

Notable Quotes & Timestamps

• Dr. Stacy Greeter on Playful Storytelling:

  “I’m hoping psychoeducational fanfiction can grow into a thing.” [05:07]

• On Special Interests vs. Compulsions:

  “So digging down into special interest: what would it be like if you were forced to stop? Well, that would be sad. That’d be terrible. I might miss it...” [10:22]

• On Nuanced Presentation:

  “That’s a whole different beast because they’re intertangled... It’s often messy. The same behavior can have multiple, multiple layers to it.” [13:28]

• On Medical System Navigation:

  “Walk into the appointment not wanting to be right, but just getting your needs met... sometimes, like, masking is a survival response.” [34:47]

• On Professional Authenticity:

  “The more I can move into a freer, vulnerable, more playful, authentically autistic self, the better psychiatrist I am.” [43:07]

• On Representation and Burnout:

  “Studies show that if you are an autistic doctor and you have worked with another doctor you believe is autistic, your rate of suicide is lower.” [52:22]

Key Timestamps for Segments

• 00:33–04:40 | Dr. Stacy Greeter’s introduction and psychoeducational storytelling approach
• 09:00–11:30 | Differentiating between OCD, special interests, and tics with lived examples
• 13:20–17:10 | Messy intersections: OCD and ego-syntonic special interests/values
• 19:05–23:00 | Struggles with ambiguity and the fantasy of the “neurotypical mind”
• 24:00–26:00 | Being openly autistic in medicine: advocacy, risk, and connection with patients
• 27:05–29:50 | Systemic medical invalidation and blaming
• 34:31–37:15 | Patient advocacy, doctor-patient roles, and masking for survival
• 39:30–41:57 | Distinguishing stimming, tics, and compulsions: chart and dragon eggs
• 43:00–47:00 | Playfulness, “play shame,” and reclaiming authenticity in clinical work
• 49:40–52:22 | Directories for autistic professionals, impact on burnout and suicide rates

Resources and Where to Find Dr. Stacy Greeter

• Website: stacygreetermd.com — includes downloadable slides and resources under the “Psychiatry Bootcamp” section.
• YouTube: Stacy Greeter MD — videos using fantasy storytelling for psychoeducation.
• Document: “How to Win at Being a Psychiatric Patient” – referenced as available by request or potentially on her website soon.
• Autistic Provider Spreadsheet: Contact Dr. Greeter for access or additions.

Episode Tone & Style

Playful, vulnerable, raw, highly relatable, and deeply affirming. The hosts and guest blend lived expertise and clinical knowledge, inviting both clinicians and clients to embrace neurodivergent authenticity and voice.

Summary prepared by PodcastGPT | For more info visit divergentpod.com