Episode 79: OCD (Part 5): Bridging Mental Health and Comedy [featuring Samuel Silverman]

Summary

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)

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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.

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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])

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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])

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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

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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.

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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.

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Transcript

[A]

Hey, everyone. You are listening to the Divergent Conversations podcast. We are two neurodivergent mental health professionals in a neurotypical world. I'm Patrick cassell.

[B]

And I'm Dr. Neff.

[A]

And during these episodes, we do talk about sensitive subjects, mental health. And there are some conversations that can certainly feel a bit overwhelming. So we do just want to use that disclosure and disclaimer before jumping in. Thanks for listening. Foreign welcome back to Divergent Conversations. Megan and I are still doing our OCD series, getting ready for OCD Awareness Month, and we have Sam Silverman here today, which I'm really excited about. I think we're both really excited about because Sam is a very unique personality who is a psychiatrist, who is a standup comedian who also has diagnoses of OCD and adhd and says more than anything, OCD has colored so much of my experience because of this, my symptoms and struggles within this condition provide much of the material for my comedy. We are really happy to have you on here, and thank you for making the time.

[C]

Thanks for having me. I'm pumped.

[B]

Yeah. I found your work, like, I think, a couple years ago, and I just. I loved it because I see, I love, like, comedy that's mental health based because when we can laugh at the really hard experience, I feel like it creates a sort of playfulness that helps us hold the hard experiences. So I've just. I've. I've been a fan of your work for the last couple of years.

[C]

Oh, thank you. Yeah. You know, I. I think that's the definition pretty much of levity is, you know, injecting humor into tragic and difficult situations. And I think that putting that up there can be really wonderful.

[B]

So, yeah, I love it. I think the other thing that's unique about you is that you talk about your lived experience of OCD as a psychiatrist, which that's something Patrick and I have talked about a bit on this podcast. But it can be really hard to talk about our struggles with mental health as providers because there's this expectation like, you should have it all together, which I know I don't for sure.

[C]

Yeah. You know, yeah. None of us have it together. I think I see it as a strength in a lot of ways, although I don't always kind of share all these different things and disclose. But to understand that all of our brains are fallible to some degree. They all have different pathways and ways that we view the world, and if we can at least understand that we're viewing through that lens, it can be somewhat helpful as A practitioner and as meeting that patient there. So I do see it as a strength. But, yeah, I know it can be difficult to talk about and talk about so openly.

[B]

Yeah, for sure.

[A]

I think it's also, you know, it almost feels like in the mental health community, therapists are becoming more, increasingly more and more encouraged to speak about lived experience. I think it feels like it's a bit safer in the therapeutic community, opposed to the medical community to some degree. And we did have an autistic psychiatrist on here talking about lived experience a couple weeks ago. And so I. I just want to say I give you a lot of credit for being in that profession and then still just openly not only talking about the lived experience, but also having some fun with it, because I think if we're always doom and gloom about this, which, let's be honest, sometimes this podcast can feel that way. It's really easy to just to really feel like defeated all the time. And I think we do have to laugh at some of the stuff that our brains are doing that we are doing as humans and some of our experiences. For sure.

[C]

Definitely. I appreciate that. Thanks. Yeah, yeah.

[B]

So I am curious a little bit about, like, your clinical context. Are you in, like a medical setting? Are you in private practice? Do you work primarily with ocd? Do you work more generally?

[C]

Totally. I. So I am one of four psychiatrists and we just hired a psychiatric nurse practitioner to a group, but in a larger multispecialty group. I don't know how many doctors, but I think it's over 200 that we have. Yeah, so covering, you know, a wide range of different things. And I exclusively take insurance. I guess there is like a cash pay rate that some people can pay because you have these mental health carve outs that people have. So if they're trying to see somebody outside of their network will try to make that work as much as possible. And I do take Medicare, don't take Medicaid, and that's just the way the group is contracted there. But yeah, I'm an outpatient psychiatrist and I see really the whole run of different things. I mean, I have people with all sorts of different anxiety disorders, depressive disorders, ocd, adhd, bipolar disorder. I have plenty of people with schizophrenia who are chronically psychotic on Clozaril. Different things there. So, yeah, I have the whole run of the mill with that there.

[B]

Yeah, yeah, yeah.

[A]

Curious about your lived experience on your OCD experience for this collection especially. So can you tell us a little bit about what that's been like for you as you pre and post psychiatric residency and present day.

[C]

Yeah, definitely. And, and they do integrate kind of nicely together in figuring it out.

[B]

The.

[C]

I, I didn't really get any mental health treatment diagnoses until I was in medical school.

[B]

Oh, wow.

[C]

Yeah. And so I would.

[B]

Can I. Yeah, I'm gonna guess that you had OCD as a child since you also have adhd.

[C]

Yeah, yeah, yeah, absolutely. Yeah. You know, retrospectively, it's, it's comical, it's tragic, but it's comical too. And you know, I, for. I, you know, we talk about different ways that it impacts our brain that are not just maladaptive, that can be positive in some ways and either between that, between, you know, other ways my brain works, I was able to get through college and get into medical school, but it really just. Both of these conditions can cause really pretty profound paralysis within those things. And I think that is really where it first started to become most obvious. Where, you know, whatever it was that I was doing to overcompensate just wasn't, Wasn't cutting it anymore. And, and that's when I really knew. I got diagnosed with adhd. Anxiety, generalized. And it really became more clear that that was OCD once I started in psychiatric residency with oh yeah, yeah. And, and then I, you know, then I would look back and see how obvious that was in just so many different ways. And we know that OCD can just ping pong to different stuff over the course of, you know, a month or certainly a lifetime. And yeah, it's, it's been really wild to, to see that into really start to understand my brain and understand that there are elements that just seem nonsensical that you should just either kind of perplex me or would become part of my normal experience that I would just push aside.

[B]

Yeah. Yeah. It's so interesting how many medical providers and therapists are coming to discover themselves as they work in the clinical population. Like, oh, as I'm doing this clinical interview. Wait, like check, check, check. Yeah, absolutely. And I recently read a study, I think I don't have it in front of me, but I think it was on average 12 years between first OCD symptoms and diagnosis. It's a really hard condition to diagnose. I think what you're saying is really spot on about. It's similar to anxiety in the sense of the monkey brain. It'll just find a new tree. So the monkey brain idea is like a monkey will hang out on a tree. Once that issue is resolved, it'll just jump to another tree. But ocd what you're saying is like, it can have a similar kind of bopping all around that makes it. It's a little chameleon, like in that it can show up in different facets of our life. It can have different flavors and so it can be really hard to spot.

[C]

Yeah, definitely. It, it. You know, the. I think the phrase that we use in OCD a lot of times, like ocd, whack a mole. And so it will like be, you know, and so like people will try to like subtype ocd. And I think that can be helpful sometimes in understanding like some really distressing elements that are at play that are focused on one particular thing. But in general I don't do that because we can see it go from, you know, one to the other to more, you know, scrupulosity, to more interpersonal and relational and all those different things there.

[B]

That's so interesting. So you don't focus on the subtypes. You. You're kind of looking more at like the meta concepts that kind of string throughout those experiences.

[C]

Absolutely. And that's a lot of how, you know, there are. I wear different hats depending on what types of conditions I'm treating and what we're trying to focus on as the goal with people who are. Have schizophrenia, chronically psychotic people who have, for lack of a better phrasing, true bipolar disorder and really become have moments of mania lasting six, nine months, things like this. I just need those people to take their medication. That's all I need them to do. And that's like the big thing that I'm focusing on. Take your medication, sleep, don't do drugs. Pretty much to start anyway with that for people with ocd, adhd and to kind of other subset with like ptsd, borderline personality disorder, those things with these groups, I'm trying to get them to understand the way their brain works to some degree, the pathways that they go into these types of things there. I think that's where we have kind of the greatest level of success, is just understanding those habits and processes that we end up in.

[B]

I love how you just differentiated that. And I absolutely. I feel like my late in life, neurodivergent discovery. So much of it has been about coming to understand how my brain works. And a lot of my healing and a lot of my restructuring of my world has come from that. I'm curious, what are some of the ways with OCD that you help folks? Like, what are some of the pathways that you feel like are really important for people to understand about how The OCD brain works.

[C]

Yeah, I think. And it's not necessarily a pathway with this part, but it's. I think the biggest thing that I want people to understand is that it's thinking of it as a doubt disorder. And that doubt can really go to anything and everything. And understanding that your brain is trying to manage that doubt in a way that it cannot do. And I think that that is kind of the biggest thing that we can think of. And so we can either think of that in terms of like, I doubt that the door is locked or the stove's off or. And then just we can see that expand quickly where I doubt that if I don't then lock the door seven times, then something terrible will happen that's catastrophic or these things and it can just ping pong to something else there, or compulsive rumination, any type of different thing. And it leads to all those different magical thinking, odd, nonsensical connections that come on there. And I think that if we understand that, that is, I think, the first place to really seeing how OCD can impact all other parts of our experience. And I also have some people who like to give like more of an extreme example, but I use it to understand, like how important this step is and how paramount it is, is I'll have people who will spend 30 minutes each time I'm seeing them talking themselves in and out of the OCD diagnosis, debating it in front of me there. They're just, they're exemplifying that doubt. And if they could understand that what they're doing is. They are, their brain is doubting the OCD diagnosis, as you would expect. And it is just compulsively ruminating around it the entire time that can make a big difference in somebody taking that step forward. So I think that's the biggest thing that I start out with.

[B]

Yeah. Yeah.

[A]

Sounds significantly less pathologizing than a lot of providers and prescribers that I've talked with. So I just want to say that it feels really affirming to hear it from that perspective and from that lens.

[C]

Thanks, I appreciate that.

[A]

So, because I think this is a big part of your journey, I do want to know about the comedy piece. So how does this start? How does it kind of progress?

[C]

Yeah, that's a great. Nobody's ever asked it that way. And that's exactly how I think about it, so. And kind of like leading up to it, to that start, I've always been somebody who's very interested in performing arts in any capacity. So, you know High school I did a lot of acting, a lot of singing college. I did more actual like singing like vocal as an instrument itself and doing vocal work there. Medical school was in my acapella group and you know, I really wanted to kind of itch that once again. And it was lacking in residency which is when I started at the end of my residency and I had been talking about doing standup. I had made some promises to my wife over and over again that I was going to start. My wife is Kelly Stevens, she's the private practice pro. And so I made promises that I was going to do it. Then I didn't follow up on that over and over again and I gave a best man speech and it did really well as kind of a comedic light hearted process. And she said that's it, I'm signing you up for class, I'm forcing your hand on it. And so that was six, seven years ago that I did that and it just, it's kind of taken off from there. I was in Southern California during my residency and I started at the end of my residency where my schedule started to open up a little bit more. So I was able to take classes, go to open mics, do a lot of shows, like do multiple things like every single day of the week if I wanted to really. And then moved up to Santa Barbara and it's, you know, I just, it's fallen in line with my life in a lot of ways because Santa Barbara is a great comedy scene but it's is on the smaller side and I can fit it into my work and into my family life. Yeah. And they provide the material.

[B]

Your family does or. And your work. Yeah, yeah, yeah.

[C]

You know, I, I probably tell the least amount of jokes about my work, but yeah, my brain.

[B]

Yeah, I would think you'd have to be careful about that.

[C]

Yeah, I, you know, I definitely don't tell jokes about my patients for sure.

[B]

Yeah, yeah. I would think that would be a really easy way to lose your license lessons.

[C]

Yeah, well, you know, maybe, you know, you'd be surprised but I think either way the it. I, you know, I, I was taking this class with at the time one of the owners of Flappers Comedy Club in Burbank. And it was, you know, you know, put in as like an advanced level class. I was probably the most novice person in the group but there are other people that had been, you know, had put up, put out specials like 10, 15 years before, things like that and done a lot of other work. So we're kind of bigger names in comedy. And they were pushing me to do more jokes with my. About my patients and kind of seeing what we could do with that. How could we explore that? And I couldn't. I tried. But what they, the feedback really was that it just didn't seem authentic with that. And so, like, it was obvious that I was not connecting to the material even as I was trying to do that. So even if I wanted to, I couldn't. But I don't want to anyway.

[B]

Yeah. Yeah. I mean, the pieces I've heard, you're really talking about your own experience and your own experiences with ocd. And I think that's what feels so impactful. And that's why I can laugh at it. Cause I'm like, I relate to this and here's someone who's making fun of their obsessive, ridiculous brain who does all of these weird things that make them feel miserable.

[C]

Yeah.

[B]

And it's funny.

[C]

Yeah, that's exactly right. And that's, that's what I'm going for.

[A]

So good to hear that sweet spot unlocked. I. I realized, like in my speaking career that I do a lot of self deprecating humor about my own autistic ADHD experiences. And the more I watch the audience laugh, the more I'm like, man, this is really energizing. I would love to do more of this. I was thinking about this in Italy last week. I was like, every time I'm on stage, people are laughing. Is there something I'm missing which is kind of part of my autistic experience? Like, it's been a really interesting journey for that, for sure.

[C]

That's awesome. That's awesome. Yeah, it is, it is really energizing. It's, it's one of the best experiences. I mean, there's a lot of anxiety behind that. And you know, I, I have not made people laugh tons of times to get to the place where I make people laugh more consistently. But even then, still, you know, not always there, but it's a lot of fun. It's a lot of fun.

[B]

Yeah. I would think it would be really hard to do comedy with ocd, right? Like the, the doubting disease. Because comedy is so hard. I remember, I think it was Adam Grant's, one of his books where he uses the example of Steve Martin who like did stand up after standup and like failed and failed and failed, and then like tried so much stand up to get to where he was eventually. But it took hours and hours and hours of just jokes, you know, falling flat to get there. Like, I Think it takes a long time to learn, like, you know, what's going to work with a room, what's going to be funny, what's going to cross the line into too much like. And then to have to be navigating all of that and all of that exposure to failure essentially with OCD like that just sounds excruciating.

[C]

Yeah, it. So it is and it isn't. And I think one of, part of it really relates to kind of once again being able to kind of at least taste that metacognition. I know that my brain is going to be experiencing that no matter what, whatever it comes down to, I'm going to be playing out that perceived or real failure or fear of failure. And that doubt across the board might as well do something with it and might as well have it in that type of way rather than just doing it in my head. Because I think that's the other trick and fallacy with that doubt disorder is kind of the next thing is you, you're not going to figure it out internally, but your brain tricks you into thinking that you will if you just evaluate it in this way. If you just look at it this angle, then you'll understand that. But there's always that next turn that comes in there. And so if I know that that's going to be happening in my brain internally, you know, I can look at that and say, hey, part of that experience is just nonsense and I can stand up in front of people a little bit easier. Still hard. You still feel that? But yeah, but it's not. But it's, it doesn't feel nearly as heavy in that way.

[B]

I really love what you just said so much. And it reminds me of actually last week's conversation. We talked a bit about act and I mentioned the inside out trap and that idea of like, I've got to fix all this inward stuff before I can move, before I can act and move forward. And I hear a lot of that acceptance of what you're saying too, of like this obsessive doubting is going to be here either way and I'm either going to be stuck or I'm going to be doing something. And yeah, that's going to give my brain fresh material, but I'm going to be like moving toward what's important.

[C]

Yeah, yeah. And I think that it's certainly a lot closer to happiness than trying to figure it out internally. Just doesn't come.

[A]

Yeah, agreed, 100%. I experience a lot of that as well. And I've always realized that I Can experience it internally and it can live internally forever, or it can come out and you can still be overwhelmed and doubting yourself and anxious. But it feels like pressure relief. It feels like a relief to just get it out into the world. And I've always found that to be so unbelievably cathartic for my own mental health as well. And I think that it's unfortunate to watch so many people keep it inside of themselves and convince themselves that it's not worthy of putting out into the world for whatever reason.

[C]

Yeah. And I think we have to acknowledge too, that moving up to that place where you feel any type of pressure relief, you will feel an increase in pressure. And I think that is often what keeps people stuck with that too, is that you will increase that tension before you get to that spot. Yeah. And there will always be a moment where it will feel like you're taking a leap and taking that first step.

[B]

And do you find that the more you've taken that leap, does that leap not non existent, of course. But does it get easier to take the more you, you have done that?

[C]

Oh, yeah, yeah, definitely. Definitely. Yeah. Like I, yeah, it. As far as, like things that I can think about that, like I've done in like the thousands of times, it's, you know, picking up a mic and telling jokes, even for just five minutes, and then having patient interactions and those things. And so like, there's always like, you know, all right, I gotta go see my next patient, but not more than that. And I think that's the same thing with, all right, I got to start telling jokes. Here we go. And you know, and a lot of times what that means is that like, I'll modulate how much like prep I'm doing for that particular night or that particular event, you know, depending on how much that pressure is too, because no sense in building that up unnecessarily.

[A]

Yeah, I would agree with that. That's, that's really well said. So it sounds like the ability to go up there, that's not only good for you, mental health wise, it's cathartic. Your wife pushed you to do it and then you come back and you work in this practice. How do you maintain separation? Sometimes if people find you on social media and they're like, hey, you're my psychiatrist, or I want you to be my psychiatrist.

[C]

Well, so I, great, great stuff there. I, I put on my social media and all those things, like, no medical, mental health stuff. You know, if, if somebody asked me to be their psychiatrist, I don't take that. I, you know, I don't buy that in. I'm in a position where, like, because I take insurance, because I take public insurance in some cases, too, they're federally funded. You know, it. I. I have a huge wait list, and so I don't do any type of, like, marketing, you know, I. It just being a psychiatrist is an awful way to have really good job security. And, you know, and I want to get people better, you know, because I have such a huge wait list. Like, it's not like I need to have anybody linger around longer than they need to. But, yeah, I think for that part, that is easier there. When my patients find me on social media, and that did not start happening until three years ago. I had one video go viral, and that's when that first started there. And that's when people started to kind of find me a little bit more. And I am in Santa Barbara. It's a town of 100,000 people. Really, probably like 200,000 when you're looking at some of the surrounding communities and areas. And so it's big, but it's not. So I also run into my patients all the time. And I say the same thing with my comedy each time, which is, you can follow me on social media. You can know that I do this here. I will warn you that you will find out a lot about my own mental health through there. And that is just your choice about what you want to do. If you want to kind of pursue that, that's totally okay. Now, if it becomes something where, like, they can't stop talking about it, try to treat the session like an open mic. Whatever else the case is, I may have to set a more firm boundary with that there. And if my material is really distressing to them and they know that there, I'm. I haven't really ever had this, but, you know, I've thought like once or twice about saying, hey, if this is going to be too much, I think it makes sense for, you know, you to either unfollow this counter, I can, you know, take a look and find your profile and block or restrict that so that way you can't see those things too. And kind of having that there. Never really got to that point, but have toed that line once or twice.

[A]

Yeah, yeah.

[C]

And that's just kind of how I do that. And it tends to work reasonably well. I'm sure there are other people that I know, there are other people that follow me that, like, have not brought it up with those things and other stuff. And that's okay.

[B]

It really, I mean, this is such a new era. We're in like, you know, our, our laws haven't caught up to the technology, our certainly our ethics, our like clinical training, our medical training haven't caught up. Like, it really is such an, like interesting paradoxical relationship when you have a public life. But then the, like, it's so personal, it's so intimate to do, to do mental health work with someone. Yeah. For me, ultimately I, I felt it was creating too much tension.

[C]

Yeah.

[B]

But I really like the way you talk about kind of the way you set up the containers, the way you set up the boundaries around that because. Yeah, it's incredibly tricky.

[C]

Yeah. And if I think if I didn't use a stage name, you know, using my mother's last name there, I think if I didn't see the wide range of people that I see, if I certainly, if I was, you know, like, like Kelly, everybody that she works with knows who she is, you know, that's totally different thing. Most people, I don't think do for me. And so there are some, some buffers with that, which is nice.

[B]

I think that'd be kind of cool to be like, I have this secret life and people don't know, like at work, people don't know about it. Like, that's like my fantasy. I would, I don't know what it is about having a secret life, but it just sounds really fun.

[C]

Yeah. Oh, yeah. All my co workers, all my colleagues know about her. Yeah, yeah, yeah, yeah. And like I'll have like other docs in the community, like randomly show up on my shows and figure it out, put it together. So. Yeah, it does happen for sure.

[B]

Yeah. How is it received in the medical community?

[C]

Pretty well. I mean, like, I think that more people in the medical community, we know it exists that we all deal with these types of things, I think. And I think doctors are opening up to that more and more. I think we still keep it a little bit more internally there because there is that self protection part. But yeah, that we all struggle with various challenges, mental health, physical health, otherwise. But yeah, it's generally well received. I, I can't think of a single time where I got anything negative. I mean, when I was applying for jobs, they thought it was cool, you know, like, I always get good feedback from other docs when they run into it, either electronically or in person. So yeah, I think it's well received.

[A]

That's great. I think it's advocacy at like, it's purest form, honestly.

[C]

Yeah. Sure. I. I would like to hope it could be there. And certainly that's. That's the type of content I like to. To cover are ones that can feel empowering or at the very least, disarming some of the places that keep us stuck.

[B]

Absolutely. It feels like advocacy to me, too. When I say, like, I say a lot of the times, you'll start a bit with, like, I'm a psychiatrist, I have ocd. Like, even that sentence in and of itself is advocacy. And it's creating awareness around ocd because, again, OCD is really misunderstood.

[C]

Yeah, I think it's one of those ocd, adhd, bipolar disorder kind of ones that people throw around in such a casual and inaccurate way.

[B]

Yeah, yeah, yeah, absolutely. Absolutely. Yeah, yeah, there's a lot of that.

[C]

Yeah, yeah.

[B]

I. So I have a theory. I'm curious, because you're in the comic world. I have a theory that a lot of comics are neurodivergent, either ADHD or autistic, specifically. Partly because I think part of what makes a good comedy comedy is it's a social critique and the ability to, like, comfortably get up and be like, isn't society weird in this way? I just feel like the neurodivergent brain, specifically the ADHD and autistic brain, that comes a little bit more naturally for us. Have you anecdotally seemed to notice, like, does it feel like there's a lot of ADHD or autistic comedians out there?

[C]

Definitely. Definitely. Absolutely. There are a ton. Yeah. And I think I. I do think that part of it is like, evaluating the world that way or evaluating yourself that way or doing those things. I think that. I think that's the case, and I think, you know, it's a. Comedy is all about complaints and confessions. And if the way you experience the world is at odds with the way that the world is, that's a complaint. You know, it's weird that this happens. It's stupid that this happens. You know, I like it. That type of stuff right there is the foundation of a setup.

[B]

So complaint and confession. I love that as a framework for understanding comedy. That is what a lot of comedy falls into.

[C]

Should be. It should be. Otherwise. What are you saying? You know, you're. Yeah, it's. I would say you look. You look at setups. Pretty much all of them, when you break it down, are going to be complaints and confessions. Otherwise, people aren't going to listen.

[B]

And they go so well together. Because if someone just complains, it's like, okay, yeah, come on. But if you combine it with the vulnerability of confession. It's like sweet and sour. You've. You've got a good combo.

[C]

You. You have to, in my opinion, either have some of those confessions there to. You have to establish credibility as a comedian one way or another. And so you have to be vulnerable to some degree. And you can either do that by really having those things where you're sharing about yourself, or you have to be. And this is a lot harder. Although there are some very good autistic comedians who do this, where you can have it be all complaints. But the way that you are able to go about the complaints is so well done that you are establishing credibility. So you're complaining about the same stuff in the same type of way, in the same type of frustration. You start to understand the way that that person's brain works.

[B]

It's almost like a confession built into the complaint. Because, like, it's a confession. Here's how my brain works and here's the it from my brain. The world is weird and here's how.

[C]

And I know that that's kind of weird in and of itself too.

[B]

Yeah.

[C]

Or could be perceived there. Yeah, yeah. So, yeah.

[A]

Love that. Maybe we will see Dr. Neff on a stage near you sometime soon.

[C]

Yeah.

[B]

Oh, like, to, like to come.

[A]

No. Maybe like as a comedian.

[B]

No. Oh, hell no. I'm not funny. I mean, in my, like, fantasy, I'm funny. And like, sometimes I hear, like, especially the social critique commentaries that I just, I. I adore. And I'm like, oh, I feel like my brain could do that, but it can't, like, pull it together. No. But I really admire when folks can.

[C]

It's a. It's an art form, but there's a science to it and you gotta know how that works. So, yeah, people who think, oh, I'm just gonna be funny and do that. The least funny people out there by far.

[B]

Yeah, yeah, yeah. I mean, that's the, like, the taking people through an experience. Like, that's what is so amazing about, like, a really good comedy is like the taking them through. And it's often a bit of an emotional roller coaster of an experience. And I love when comedians would be like, I like Hannah Gatsby does this. Like, this is the experience I'm going to take you on, and then they actually take you through that experience. And it's just like the meta communication about, here's what you're going to experience and then you do it. I don't know. It's just, I. I think comedians are very Good communicators and very good at unders. Like having a pulse on the human experience.

[C]

Yeah, well, so, yeah, certainly. Certainly those who make it are. Yes.

[B]

Yeah.

[C]

Like that there. Yeah, yeah. But. But yeah, I think that that's the thing. If, if people are connecting to your material, you're probably somebody who has a good pulse on that experience.

[A]

Yeah. Great. I was just watching John Mulaney's stand up of like him walking you through his addiction experiences and his recovery experiences, and it's one of the funniest things I've ever seen in my life. And it was just so, so relatable and so real where it's just like. Yeah, we're. This is. This is outrageous, but it's hilarious.

[B]

Yeah, yeah, same thing. I'm blanking on her name, which so I almost didn't want to say this because I'm embarrassed. I'm blanking on her name. She has several specials on Netflix. She talks about bipolar and religious trauma, which I relate to. And she hosted late night show now.

[C]

Oh, Taylor Tomlinson.

[B]

Taylor Tomlinson, yes. I have loved her comedy this last year and have found it. Yeah. Again, like a great combination of a critique of society and also a lot of confession.

[C]

Yeah, yeah, absolutely. Yeah. She. She's great. I really enjoy her too. Yeah.

[A]

Well, Sam, I know you mentioned having a hard stop at the hour and I want to honor that and just want to ask if there's anything you want to share with the audience as we're kind of getting ready to wrap up, or anything that you want to share with them in terms of how they find you or any of that information.

[C]

Oh, I. Well, I. You can find me. I'm. I'm on social media. I hate it. But you can find me there. It's a Sam Silverman comedy on Instagram and you can probably Google and find any other of my profiles, but that's the only one I really use. Yeah. So maybe I was.

[B]

Oh, sorry.

[A]

Go ahead.

[C]

Yeah.

[B]

Well, I'm so curious why you hate it. Because I have a. I always joke. I'm like, I'm the most anti social media, social media person that I know, but maybe not.

[C]

Yeah, I know. Oh, man. I. There's so many reasons. It. It's a time suck. It's designed to be addictive. I think there's a lot of. It's super fake in a lot of ways. I think it worsens people's self esteem. Not well regulated in terms of information. Yeah. I mean, list goes on and on. Yeah. Not a big fan.

[B]

Yeah. Yeah, yeah, yeah. It can be a powerful tool for education and there's a lot that comes with it. And, yeah, I've been struggling with that as well. And sometimes I'm like, am I contributing to this? And should I get off? And. Yeah, but, sorry, I think I interrupted. Are there other places people can find you so they can find you?

[C]

Yeah, that's really. That's really the big one there. Yeah. Find me on social media, Instagram. And yeah, I would just say OCD is tricky and it makes you think that you don't have it. So something worthwhile if. If you're unsure about what's going on internally.

[A]

That's a. Yeah, that's a very real statement. So it's a great way to wrap that up. And, Sam, we appreciate you coming on. We know you're busy, and thank you so much for making the time to be on here as a guest.

[C]

Thank you so much for having me. It's awesome.

[A]

And to everyone listening to Divergent Conversations, new episodes are out on Fridays on all major podcast platforms and YouTube like download, subscribe and Share. And good night.

[C]

Foreign.

[B]

Hey, it's Dr. Neff here. This season, we are clearly talking about autistic burnout, a topic that neurodivergent Insights has covered extensively. So if you would like more resources to supplement your learning, we've put together a page where we've curated all of our autistic burnout resources, Freed and paid resources. We have lots of articles on autistic burnout. We have a upcoming free email course. It's going to be released soon. We have workbooks on autistic burnout. So if you'd like to check out our resources again, both free and paid, you can go to neurodivergentinsights.com burnout resources. It's linked below and in the show notes. I hope you don't need these resources, but if you do, they are there for you.