Divergent Conversations

Episode 79: OCD (Part 5): Bridging Mental Health and Comedy

Featuring Samuel Silverman
Release Date: November 8, 2024
Host(s): Dr. Megan Anna Neff & Patrick Casale
Guest: Samuel Silverman (Psychiatrist, Stand-Up Comedian, OCD/ADHD Diagnoses)

Episode Overview

This episode explores the intersection of mental health and comedy, focusing on Obsessive Compulsive Disorder (OCD). Hosts Dr. Neff and Patrick Casale sit down with psychiatrist and comedian Samuel Silverman. Together, they discuss the value of humor when coping with mental health challenges, the lived experiences of clinicians with OCD and ADHD, the complexities of OCD diagnosis and treatment, and the unique boundary navigation required when clinicians share their stories in public spaces.

Key Discussion Points & Insights

1. Introductions & Framing

• Patrick introduces guest Sam Silverman as a psychiatrist, comedian, and someone with personal OCD/ADHD experience.
  • Notable introduction: “...Sam is a very unique personality—psychiatrist, standup comedian, also has diagnoses of OCD and ADHD... provides much of the material for my comedy.” (00:33)
• Dr. Neff shares her appreciation for comedy rooted in mental health experiences, emphasizing how humor can transform hard experiences into something more manageable (01:13).

2. Lived Experience as a Mental Health Provider

• Sam describes the strength and vulnerability in sharing lived experience as a psychiatrist, acknowledging the fallibility of all brains and the empathy that creates in clinical work (02:13).

  • "To understand that all of our brains are fallible to some degree… it can be somewhat helpful as a practitioner and as meeting that patient there." — Sam ([02:13])

• Patrick and Dr. Neff reflect on differences between the therapeutic and medical communities regarding openness about clinician mental health struggles, giving Sam credit for his openness (02:54).

3. Clinical Context & Practice

• Sam outlines his work in a large, multispecialty group, taking various insurances, and treating a wide range of mental health conditions—not just OCD (04:04):
  • “I see really the whole run of different things... all sorts of different anxiety disorders, depressive disorders, OCD, ADHD, bipolar disorder... plenty of people with schizophrenia..." — Sam ([04:04])

4. Sam’s OCD Experience: Before, During, After Residency

• Onset and Diagnosis:
  • Sam was not diagnosed until medical school, despite clear childhood symptoms of OCD and ADHD (05:51).
  • He describes the “paralysis” both conditions caused, which became unmanageable during medical training and led to proper diagnosis (06:02).
• Retrospective Realization:
  • “Retrospectively, it’s comical, it’s tragic, but it’s comical too...” — Sam ([06:06])
• OCD’s Shifting Manifestations:
  • Discusses the “ping pong” nature of OCD, with symptoms shifting focus throughout life (07:49).

5. Challenges in Diagnosing OCD

• Dr. Neff references studies showing a 12-year gap, on average, between symptom onset and diagnosis (07:49).
  • She likens OCD’s shifting focus to the “monkey brain” concept: “Monkey will hang out on a tree... once that issue is resolved, it’ll jump to another tree...” — Dr. Neff ([08:51])
• Sam’s Clinical Approach:
  • Avoids rigid subtyping of OCD and instead focuses on understanding “meta-concepts” and pathways (09:29).
  • “The phrase that we use in OCD a lot of times... OCD whack-a-mole.” — Sam ([08:51])

6. Helping Patients Understand OCD

• Doubt Disorder Framing:
  • Sam emphasizes framing OCD as a “doubt disorder,” explaining that compulsions and ruminations are the brain’s (futile) attempts to resolve persistent uncertainty (11:19).
    • “...it's thinking of it as a doubt disorder. And that doubt can really go to anything and everything.” — Sam ([11:19])
  • Shares clinical anecdotes about patients compulsively doubting even their OCD diagnosis during sessions (12:57).

7. Comedy as Catharsis and Advocacy

• Sam’s Comedy Journey:
  • Came to stand-up at the end of residency, after years of performing arts involvement (13:51).
  • On using comedy: “It’s fallen in line with my life in a lot of ways... my family and my work provide the material.” — Sam ([16:15])
• Material Focus:
  • Does not joke about patients; focuses on personal experiences: “Even if I wanted to, I couldn’t. But I don’t want to anyway.” — Sam ([17:34])
• Impact on Audience:
  • Dr. Neff: “Here’s someone making fun of their obsessive, ridiculous brain who does all these weird things that make them feel miserable. And it’s funny.” ([17:54])

8. Navigating Comedy With OCD

• Exposure and Failure in Comedy:
  • Dr. Neff highlights the intense vulnerability of comedy, especially for someone with OCD ([18:59]).
  • Sam explains that the ever-present doubt is there “no matter what,” so taking the stage is better than being stuck internally ([19:50]).
  • “Part of that experience is just nonsense, and I can stand up in front of people a little bit easier.” — Sam ([19:50])

9. Boundaries Between Clinical and Public Life

• Handling Patient Encounters:
  • Sam clarifies boundaries on social media, in-person encounters, and public content: “If somebody asked me to be their psychiatrist, I don’t take that... I don’t do any type of marketing...” (24:48).
  • On patient reactions: Most are supportive, but Sam maintains boundaries if it becomes intrusive to clinical work ([24:48], [27:43]).
  • On using a stage name: Adds a layer of buffer between clinical and comedy identities (28:43).

10. Reception Within the Medical and Comedy Communities

• Medical Community:
  • Says the medical community is increasingly open, and his advocacy is well-received; doctors appreciate the dialogue about mental health among providers ([29:40], [30:34]):
    • “I think it’s advocacy at its purest form, honestly.” — Patrick ([30:34])

11. Comedy, Neurodivergence, and Social Commentary

• Dr. Neff’s Theory: Comedy attracts neurodivergent people because of their unique angle on social critique ([31:38]):
  • “Comedy is all about complaints and confessions...” — Sam ([32:15])
  • “If the way you experience the world is at odds with the way that the world is, that’s a complaint... that’s the foundation of a setup.” — Sam ([32:15])
• Vulnerability and Connection:
  • Complaints and confessions allow comedians to establish credibility and connection ([33:08]).

12. Closing and Resources

• Where to Find Sam:

  • “You can find me… Sam Silverman Comedy on Instagram.” — Sam ([37:56])
  • He expresses ambivalence about social media, listing its addictive design, fakery, and self-esteem issues ([38:18]):
    • “It’s a time suck. It’s designed to be addictive... I think it worsens people’s self esteem. Not well regulated… Not a big fan.” — Sam ([38:26])

• Final Reflection:

  • “OCD is tricky and it makes you think that you don’t have it. So something worthwhile if you’re unsure about what’s going on internally.” — Sam ([39:13])

Notable Quotes & Memorable Moments

• “Retrospectively, it’s comical. It’s tragic, but it’s comical too.” — Sam ([06:06])
• “The phrase that we use in OCD a lot of times... OCD whack-a-mole.” — Sam ([08:51])
• “It’s thinking of it as a doubt disorder. And that doubt can really go to anything and everything.” — Sam ([11:19])
• “If the way you experience the world is at odds with the way that the world is, that’s a complaint... that’s the foundation of a setup.” — Sam ([32:15])
• “Comedy is all about complaints and confessions.” — Sam ([32:15])
• “OCD is tricky and it makes you think that you don’t have it.” — Sam ([39:13])

Timestamps for Key Segments

• Intro & Guest Welcome: 00:00–01:10
• Discussing Lived Experience as Providers: 01:34–03:46
• Sam’s Clinical Context: 04:04–05:22
• Sam’s Personal OCD Journey: 05:26–07:49
• Difficulty in Diagnosing OCD: 07:49–09:29
• Clinical Approach to OCD (Meta-Concepts, Habits): 09:41–11:19
• OCD as a Doubt Disorder: 11:19–13:21
• Comedy Journey & Integration: 13:39–18:29
• Doing Comedy With OCD: 18:29–21:24
• Navigating Boundaries in Public/Clinical Life: 24:20–29:37
• Reception Among Colleagues: 29:40–30:34
• Comedy and Neurodivergence: 31:38–34:27
• Comedy as Social Critique: 35:23–36:52
• Closing Reflections & Where to Find Sam: 37:56–39:13

Episode Tone & Style

The episode is open, conversational, affirming, and infused with humor, often blending vulnerability with light-heartedness (“raw, vulnerable, affirmative as hell”). All speakers are candid about their experiences as neurodivergent clinicians and individuals, seeking to break down both the stigma around clinician mental health and the shame often inherent in discussing OCD.

Conclusion

This rich episode offers both personal and professional perspectives on OCD, illustrating the power of humor and vulnerability in mental health advocacy. It highlights the challenges of living—and practicing—as a neurodivergent clinician, the clinical intricacies of OCD, and the unique role that comedy can play in making space for these conversations.

Find Sam: @samsilvermancomedy on Instagram

Resources: For more OCD and autistic burnout resources, visit neurodivergentinsights.com/burnout-resources.