Episode 72: Chronic Health (Part 3): Megan’s Biopsychosocial Assessment
Sep 19, 2024
Show Notes
By exploring biopsychosocial aspects of life, it can become easier to understand our nervous systems from a holistic perspective offering more options to improve our quality of life with simple and manageable changes.
In this episode, Patrick Casale and Dr. Megan Anna Neff, two AuDHD mental health professionals, explore the biopsychosocial aspects of chronic fatigue and long COVID, and how these affect one's social life and overall health through the lens of Megan’s experiences.
Top 3 reasons to listen to the entire episode:
- Learn about realistic and attainable goal-setting to overall health using a biopsychosocial approach, highlighting why it's important to avoid extremes and embrace small, achievable changes.
- Gain insight into how personal struggles and professional advice sometimes contradict, as well as discover a more holistic perspective that underscores the importance of authenticity.
- Discover the psychological and biological dimensions of Megan’s chronic fatigue and long COVID, and how these affect her social life and overall health.
As you listen, consider how you can apply these discussions to your own life, setting realistic goals and fostering a sense of balance. Make self-care a priority, and remember that small, positive changes can create ripple effects that significantly enhance your mental and physical health.
DISCLAIMER: This episode is not intended as medical advice.
Resources:
- Biopsychosocial Venn Diagram Download: https://drive.google.com/file/d/1W8zJvBOcokPqW2OIi70hIhlqmJcowdKA/view?usp=sharing
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Transcript
PATRICK CASALE: Hey, everyone. You are listening to the Divergent Conversations podcast. We are two neurodivergent mental health professionals in a neurotypical world. I'm Patrick Casale.
MEGAN NEFF: And I'm Dr. Neff.
PATRICK CASALE: 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. And thanks for listening.
Hey, everyone. Welcome back to Divergent Conversations. You may have just listened to the episode where Megan did my biopsychosocial live while we were recording about my sleep issues. We had the idea that we were going to immediately do Megan's biopsychosocial, we forgot. We started recording an OCD series. And here we are re-visiting this.
MEGAN NEFF: I don't think we forgot. I think it was, like, poor time management and scheduling.
PATRICK CASALE: I think Megan's right, so poor time management and scheduling. And here we are. But this is going to come out the week after you all listen to my episode.
And Megan, you did this Venn diagram for yourself. When you did mine, you were typing it in, and I was giving you the information. So, this is going to feel a bit different. What was it like creating this Venn diagram for yourself? And tell the audience, like, what are the things that we are focusing on today?
MEGAN NEFF: Yeah. So, I think the big because, like, with you we had a question. And I think it's helpful when you do this to have a question in mind, and yours was sleep. And so, for me, when I was writing this and I was doing it last night, kind of the theme that I've been exploring is this idea of stuckness in my health journey. And so, it's very much connected. I think the really big thing is fatigue. That's the thing. If I could push the needle even a little bit on my fatigue, I feel like that would be huge for me.
So, fatigue. But, like, really long COVID. Like, I just feel like over the last four years I've been watching my health decline. And that scares me. And I feel like I'm in some pretty bad cycles with it. And so, that was kind of the big thing around, like, long COVID, stuckness, with an eye of, like, okay, how am I going to get unstuck?
And it's been something I've been thinking a lot about, frankly, since we recorded yours. In my newsletter, I've been sharing more about this idea of, like, getting stuck in a defensive monotropic mode where I, like, go into monotropic mode as a way to escape my life. And monotropic mode is that, like, deep, singular focus that is a place of joy for a lot of us, but I've noticed myself, I go into it defensively to escape my life.
PATRICK CASALE: Sure.
MEGAN NEFF: And I'm realizing, while that is a powerful way for me to self-soothe, it's also creating other problems in my life.
PATRICK CASALE: Yeah, yeah, yeah, absolutely. One, I want to just, you know, I think when we're talking about this stuff that we're recognizing for ourselves there's a lot of vulnerability in these conversations. And I just want to, like, really name and honor that as we go through your Venn diagram that you've created because I know as a friend and colleague, like, how much this has impacted you in every area of life, and that's what we're talking about, for everyone listening. And if you're listening, we are sharing our screen on the Venn diagram, and you can find that visual on YouTube. So, make sure if you want to visualize this, check it out there.
So, we're talking about feeling chronically fatigued, we're talking about long COVID. There's, obviously, a lot of symptoms and impact that come with this. Where are you noticing this the most, in terms of the biopsychosocial component? Like, what's really coming up for you when you think about how this is impacting you?
MEGAN NEFF: Yeah, and I mean, this is why I really like this framework because I see it really holistically. So, I guess, to start with the bio. Like, honestly, I still don't fully understand what's happened with my body. I did do an OATS test, which is a pretty cool test that will look at kind of different things that might be going on with the body. And I do have a protocol I'm going to try that I feel a little bit hopeful for. But I just know there's a lot of systems in my body that aren't working well right now, a lot of inflammation.
On that OATS test my vitamin C came back in like 0-2%. Like, I think that my body's just burning through any vitamin C it does get because I'm always sick, which that may be also explaining why I'm always sick because I have, like, very little to no defense system.
So, I think part of what I've noticed is it's very rare for me not to be sick. Like, right now, as we're recording it's middle September, I got sick end of July. I had a six or seven-day stretch beginning of September where I wasn't sick. It was amazing. And now I'm sick again.
So, it's just I am chronically sick. And when I get sick, often, my reactive airway stuff and my asthma acts up, and like, there's pain, and then, movement gets a lot harder. Often, I get more brain fog when I'm sick, and the fatigue kind of accelerates. And I haven't been diagnosed with POTS, but I have a lot of the POTS symptoms of kind of, like, headedness and things like that.
So, biologically, just like sickness, fatigue, asthma that influences social life quite a bit. For one, before I got COVID I was a, like, avid exerciser and it was my huge outlet. And like, I feel so distant from that person, that body that could do the things I could do. And so, like, my movement has become so limited. And I think some of that's psychologically impacted, which we'll get to, right? But some of it's biologically impacted of just it's harder to move.
When I go on a walk, like, I will often bring my inhaler because like it's hard. And then, I retreat. I'm terrified of getting COVID. And the world has moved on from COVID. And so, I isolate, partly, because I'm so tired. And for me, like, because people often ask, like, "How can you do so much?" Like, I'm literally often, like, sitting in sweatpants on my computer-
PATRICK CASALE: Absolutely.
MEGAN NEFF: …most of the day. But I have, like, a lot of body fatigue. So, whenever I exert my body is where I experience a lot of fatigue. So, fatigue is one reason I don't go out in the world, and then, that exasperates my sensory stuff. But it's also just, like, well, is going to a coffee shop to do work that sounds nice, but is it worth the risk of exposure? Or is going to see this person that sounds nice, but is it worth the risk of exposure? So, that's-
PATRICK CASALE: So, it's just like constant [CROSSTALK 00:08:56]-
MEGAN NEFF: Constantly.
PATRICK CASALE: …calculation of that cost-benefit analysis of like, and that's got to be unbelievably exhausting and honestly, frustrating at times too when you're having that mental dilemma.
MEGAN NEFF: Yeah, absolutely. It's exhausting, which is why it's easier just to, like, I think, retreat into these patterns of isolation. So, my social life looks very different. And some of that's like discovering autism and deciding not to go to places that are, like, sensory overwhelming or where I would be masking a lot. So, it's weird.
I discovered autism and got COVID within the same year span. So, like, these things are also intermingled in really complex ways for me, but that's kind of how it shows up socially.
And then, the other big social factor is we had a pretty big place disruption in 2022, was it? Like, our school, like, we were very anchored into kind of a small community. My spouse worked for the school district, had kind of a high-level job there. It was really meaningful work for him. It felt like we were giving back to our community. We were rooted. And the school board was radicalized and made a series of terrible decisions, including firing the superintendent who was a really effective superintendent, who was, like, my spouse, Luke, like, worked so closely with him. And we kind of saw the writing on the wall that there's just going to be budget nightmares, and it was not a queer affirming space anymore. So, we moved, but we moved to Portland, and like, we don't have community here. So, there's this huge place disruption that also happened amidst all of this. So, that's another social factor of my diagram.
PATRICK CASALE: Right. And it looks family tension as well. I imagine with place disruption it really impacted a lot of that too.
MEGAN NEFF: Yeah, the family tension, that's an interesting one. We moved to Oregon partly because my family's here, but there's been, like, percolating family tension, mostly, with me and one of my sisters. We're very different personality-wise. And I see things very differently, have very different defense structures, and it's just, as our kids are all around the same ages, and like, it's just kind of gotten to a tipping point that's painful to where the social system I would have in Oregon is one that feels pretty difficult at the moment. So, that's how that wraps into my social diagram.
PATRICK CASALE: And that, you know, as we're talking about this from a holistic viewpoint, we can see why this all bleeds into the psychological part of this diagram, right? The depression, anxiety, some of the other symptoms and traits that come with this, the anxiety, the grief, and regret. Like, this all is intertwined and interwoven. So, it's just amazing how impactful, you know, one event certainly starts this, like, domino effect into all of these experiences.
MEGAN NEFF: Yeah, yeah. And why it's so much more complex than, like, well, let's try this one thing. It's like, okay, let's look at it holistically of there's so many components. Exactly, yeah, that's really well said, yeah.
PATRICK CASALE: So-
MEGAN NEFF: Yeah.
PATRICK CASALE: Go ahead. Sorry.
MEGAN NEFF: Oh no, go ahead.
PATRICK CASALE: You know, when we look at these things, I know how overwhelming they can feel and how they can kind of create, like you said before we started recording, you were like, "Oh my God. Like, I'm looking at this, and this is kind of depressing me. This is making me feel pretty…" I don't want to put words in your mouth, "It's a lot to take a step back and look at this and feel like where do I go from here?"
And I think that's what we're trying to figure out, right? Is like, where do we go from here when all of these things are simultaneously happening and we don't have one specific answer? And, like my sleep situation, I know we have to break it down in small steps. I know we have to, like, work on one little thing at a time and hope to build momentum because if we try to fix or change everything it feels insurmountable.
MEGAN NEFF: Yeah, exactly, exactly. And that was my experience last night. I was like, "Oh, gosh. Like, it's so easy to get overwhelmed by this." And so, that's where we get to the question of, like, okay, where's the thing that's going to push the needle forward? Yeah.
So, I think for me it's both biological and psychological are some of the places I want to push the needle forward. Maybe I'll just review the psychological components first.
PATRICK CASALE: Sure, yeah, yeah.
MEGAN NEFF: So, let's see, yeah. I mean, I talk pretty openly about, like, depression, anxiety, OCD on here. And I think the depression, yeah, I think it does have biological components. Like, in the OATS test, one of the things that the person I consulted with, a psych NP, and she did a really cool, like, comprehensive.
And I hadn't told her my history. And, like, before she met me she was like, "Yeah, I was guessing you were probably experiencing some depression and maybe ADHD." Because my serotonin and my dopamine are just so low, which showed on the test. So, I know the depression, like, has some, like, organic basis to it. But then, I think, like, the social pieces I just articulated obviously, also, tie into depression, or just, like, the experience of chronic pain, chronic fatigue, the changes.
And then, the grief, and regret, and the thoughts about fatigue, I want to kind of talk about that because I think this gets misunderstood a lot when we start looking at the psychological components of complex health. I will start having a lot of panic thoughts around my fatigue. So, like, organ grayness has just come down, and like yesterday, and I don't know if it's sickness, I don't know if it's the sun has gone away, but I felt the wall of fatigue that is so familiar to me in the fall and winter. And I went up to Luke, and like, he just held me, and I was like, "I am so tired, this is so painful."
And when I have thoughts about the fatigue, or when I have the grief and regret. So, the grief and regret is about the fact I was keynoting, I was giving like a TED Talk-style keynote at a conference. It was March of 2020. I was, like, waiting for them to cancel the conference because it was the week everything was closing down. I didn't want to not go since I was keynoting, but I went, and I got COVID. And I came back, and I gave it to my daughter, who's also had long COVID.
So, I have so much grief and regret around how I got it. So, whenever I have a symptom, right? This is how, like, neural associations work, when I have a symptom of fatigue or when I have a like an asthma flare-up, those scripts, sometimes consciously, sometimes unconsciously start playing, and that activates my stress response, and that activates my cortisol, and that activates my inflammation. So, when we're maybe working with a therapist around, "Well, what's your story around your illness?" It's not because it's like, "Oh, it's all in your head." But it's these things can start pairing in complex ways, so that every time you experience that sensation of pain or every time you experience it's hard to, like, get a breath in. If that's activating those stress scripts, ultimately, that's not very helpful for us.
And I know I have a lot. Like, I have a lot of grief to… Like, that was one of my ahas. I was like, "I think I have a lot of like unprocessed grief around this." So, that was one of my ahas yesterday with the psychological component.
PATRICK CASALE: That's a big one. That's a huge almost, epiphany moment of this is what's coming up for me every time I experience a symptom, or every time I get sick, kind of flashing back to that moment of going to keynote, understanding to some degree what was happening in the world. And I see the FOMO and the overlap. So, I imagine some of that was like professional FOMO of, you know, "If I don't go and how does that impact my reputation?" Like, I imagine a lot of that was going through your head at that time.
MEGAN NEFF: Totally. And I also was feeling very anxious. Like, because it was Ted Talk style, I had been prepping for nine months. I had it memorized, like, in my body memorized but I was very anxious because it was the first keynote I'd ever done. And I was like, "If I don't go, is that me letting the anxiety win?" And so, I kind of push myself to go knowing I'm someone who has anxiety. So, yeah, yeah.
PATRICK CASALE: Yeah.
MEGAN NEFF: Okay, but here's my other big aha moment that I'll share. And this is one of the places I think I need to, like, dig a well and push the needle. I haven't pulled on my psychological circle manic defense. This term comes from more like psychoanalytic terminology. It's not to be confused with mania, as in often in the context of bipolar. But a manic defense is basically where your defense structure does, like, the opposite of what you're feeling to escape feelings of like helplessness.
So, it can be common with depression. For example, where if a person has a manic defense to their depressive, like, structure or experience of depression, they might be really busy in projects and creativity. They're basically doing anything they can to escape the reality of the depression that would make them feel really helpless.
And I was realizing, I think I've been functioning in a manic defense structure of which is partly why I'm such a workaholic, of I feel so helpless when I think about my health issues that it's like, well, maybe, you know, if I build one more workbook, if I do one more thing it's… And I can tell it's a defense against feeling the grief, feeling the helplessness of how much my life, how much my body has changed in the last four years.
PATRICK CASALE: That's huge. That's a huge revelation, too. And it makes so much sense why you would deep dive into your work to kind of escape that reality. Because if you're not working, I imagine you're spending a lot of time either by yourself or in your home, and your brain starts to ruminate on these things. Your brain starts to really fixate on limitations and newfound capacity. And I imagine that grief just then intensifies.
MEGAN NEFF: Yeah, yeah, absolutely.
PATRICK CASALE: Because you and I have talked so much about working and workaholism on this podcast, and I think we can both agree that we both may struggle with workaholism. And I think a lot of autistic business owners do. And I think that we are in our homes a lot where we feel comfortable and we're like doing things that we typically love or are really interested in.
But when we step away from that, when we step away from the workaholism and we have the realization of, "Damn, this is a defense mechanism for me." It is protecting us, right? It is protecting us from overwhelm. It is protecting us from grief. It's protecting us, potentially, from anxiety or depression. So, I do look at it as like a double-sided coin in a way. And I think that's why it's sometimes so hard to separate from.
MEGAN NEFF: Yeah, there's this quote I love, I believe it's from Lacan, another psychoanalyst who talks about, like, enjoy your symptom. I mean, obviously, we want to work through our depth issues. And then, sometimes it's like because our symptom can have a double-edged sword, especially, for workaholism, like capitalism rewards that, society rewards that. Like, there's a lot of reinforcers that reward that. And so, that is a hard one to disentangle from.
PATRICK CASALE: I agree 100%. There's so much there that we can explore in terms of why workaholism is protective. I think a lot of these symptoms are protective. Like, anxiety is protective. You know, depression, at times, can also be protective in certain ways. So, I think we also label these things as negative as society a lot of the time. And I think that that's something to pick apart as well.
So, with all of this being said, as we're looking at this through this lens, where do we go from here as some of the steps that you want to pursue, or the things that you feel like could alleviate 1%?
MEGAN NEFF: Yeah, so actually, I think I have, like, a goal for each of the circles, each of the Venn diagrams. So, biologically, like I did this OATS test, which, that's a funny story, I couldn't do it, but it took me six months to finally do it. I had to pee in a cup and send it back. And I got so overwhelmed with the paperwork that, like, it took me six months to do it. And I was like, "This is such a silly thing." But also, I totally get it.
I finally told Luke, I was like, "I think I need to body-double this." Not body double body pee in a cup, but, like, the paperwork.
PATRICK CASALE: Sure.
MEGAN NEFF: That was the only way I could get myself to do it.
PATRICK CASALE: [CROSSTALK 00:22:30].
MEGAN NEFF: Yeah, so that. And then, the psychiatrist I met with who, like, gave me a really beautiful report around it, gave me a protocol which was so helpful. And she explained, like, I've always suspected I had candida or gut overgrowth. I've been on so many probiotics because I had strep non-stop a few years ago. Like, I've just been on so many probiotics, oh not probiotics, antibiotics. And that was one of the things confirmed.
So, like, she was like, "Yeah, even if you're taking vitamins, your small intestines aren't absorbing them." And she explained it in a way that, like, my brain actually could understand. I don't think I could repeat it now, but, because brain. But I was like, "Okay, that makes sense." So, the first month of the protocol is like addressing the candida. I don't think I'm saying that right, by the way-
PATRICK CASALE: [CROSSTALK 00:23:27]-
MEGAN NEFF: But addressing the gut [CROSSTALK 00:23:28]-
PATRICK CASALE: …in my life. So, however you say it it's fine with me.
MEGAN NEFF: Oh, you should look into like, so leaky gut. Like, a lot of autistic people, like, we're more prone to gut issues. And leaky gut, there's been interesting research coming out the last handful of years, but it's really connected to a lot of kind of whole system health issues.
And then, I have like a six-month protocol of like, I'll add in, like, vitamin C supplements, vitamin B. That was another one that was really low. I'm a vegetarian, but that's going to be hard to kind of say. And like, that's probably a really hard diet for you because you've got a lot of B vitamin stuff going on.
So, I might incorporate fish. That's like a values conflict for me, which there's a lot of values conflicts when I start thinking about my health and my values. But yeah, so I've got a plan for the biological, and it's like addressing gut issues, and moving forward.
For the psychological, I'm working on the manic defense, which involves… I have to find a framework to actually process the grief. I'm not sure what that'll look like yet, but I do need to, like, stop this whole emotional avoidance of the grief and the denial.
PATRICK CASALE: Well, how is it [CROSSTALK 00:24:54]-
MEGAN NEFF: So, that's [CROSSTALK 00:24:55].
PATRICK CASALE: …on air right now.
MEGAN NEFF: It's a little bit scary. Yeah, it's so interesting being in like the wellness and I'm saying that with quotes because I don't like the idea of being like a wellness person. It's so interesting to be, though, in the wellness sphere where I am giving people recommendations and ideas, and then, to be also so open about like, yeah, I'm in the trenches with you, like figuring this stuff out for me too, and like addressing emotional avoidance, and figuring out how to move toward emotional acceptance of this thing that feels really, really big.
And it feels so big because it's not just my health, it's my child's health. And I think if it was just mine, it wouldn't feel so huge to look at and process.
PATRICK CASALE: Makes a lot of sense. When it comes to offering advice and support while also needing similar advice and support, I think that just makes you more human, from my perspective. You know, I think I don't know a single person who's like, I don't want to say holistically well, because that's not the term, but I believe we're all struggling with some of this stuff in some degree or capacity. So, I just think it makes you more of a real human being who's also struggling with their own stuff as well.
MEGAN NEFF: Well, thanks. I like showing up in my humanness, but I also realize sometimes I'm like, yeah, I realize I just talked about, like, a pacing system, and I realized, like, my pacing sucks when it comes to work.
PATRICK CASALE: Isn't that typical, though, for so many of us to be able to really offer good advice and support while not being able to also simultaneously incorporate the same advice and support?
MEGAN NEFF: Totally. I mean, the workbooks I create, I create them because I'm struggling with it. And I'm like, I want to figure out alexithymia, or I want to figure out interoception, or I want to figure out habits because I'm struggling with these things.
PATRICK CASALE: Exactly.
MEGAN NEFF: So, then I go make a workbook on it, yeah.
PATRICK CASALE: I think that's always why people have been drawn to me when I'm talking about stuff I'm struggling with publicly because it just makes the human experience more relatable because people can see things through certain lenses, right? Like, you've got it all together, you're doing all these things. It's like, no, fuck no, I'm not. Like, I am in my house 99% of my life. But I do think it makes it just more relatable, so…
MEGAN NEFF: So, yeah, one tangible thing I'm doing, like, in the psychological component is I'm starting to put guardrails on when I start work. I realized, so with the workaholism which is tied into the manic defense, like, I don't think I do things that are good for my health, like go on walks because I'm, like, constantly feeling pulled to work. So, that's one very tangible thing I'm doing is like I'm not allowing myself to start work before 9:00 AM. I knew it'd be harder to give myself a stop point because some of my best energy comes at night. So, that's one thing I'm doing there. And then, socially, I am, like, getting out of my sweatpants.
PATRICK CASALE: I saw you in a tan or brown sweater the other day, and I [CROSSTALK 00:26:36]-
MEGAN NEFF: And I'm wearing overalls today.
PATRICK CASALE: Yeah, I was like, "Megan, you're not wearing black. Oh, great."
MEGAN NEFF: I know. Well, usually, my attire for like the last three years has been like a black fairy turtleneck, and I have like five of them, and they're really comfortable. And then, like, sweatpants. And it is very comfortable. But I think it kind of, on some level, is supporting the, like, sick fatigue mentality versus like, okay, I'm getting dressed for the day. And like, it does. It kind of changes the mindset a little bit.
PATRICK CASALE: I think you're almost when we're doing these little things, making these little tweaks, it's almost creating those neural pathways of like, okay, I'm going to get dressed for the day. I'm going to approach this day differently. I'm going to have almost a little bit of mindset shift that maybe I might feel better, or get through one ounce of this day with more energy. I think it does create that perspective for sure.
MEGAN NEFF: Yeah, yeah. And with it, I am trying to get out the house more, even with my anxiety about exposure. Like, my kids are both at school, so I'm already getting a bit of exposure. So, and it's the first time we've had two kids that go to school since 2020. Like, usually we've had a kid at home. So, Luke and I are trying to take advantage of that, like go to lunch once a week, or to go to a coffee. Like, we went to a coffee shop earlier this week, partly because we didn't have internet at the house, but also just like to try something new, and we worked.
And I am realizing that that also is, like, helping me kind of get out of some of the ruts that I've been in of like, you know, rolling out of bed in my sweatpants, get on the computer, stay on the computer. So, that is like, actually, getting dressed for the day beyond sweatpants. And that actually makes it easier to leave the house too, because it's not like, oh, well, I don't want to get out of my sweatpants.
PATRICK CASALE: No, I think that's huge. And for those of you listening, like, it doesn't take, even though that energetically or psychologically can feel like a massive thing to do, to not get into sweatpants immediately in the morning, it is a small step that can really have a lot of impact and a lot of result. So, it doesn't have to be like we have to figure this entire holistic viewpoint out in one day. It's just like one little thing a day that is moving us towards our goals.
MEGAN NEFF: Yeah, and figuring out what that little thing is. And also, like, I don't want to, like, put a bad rap on sweatpants. Like, sweatpants are great, and they're such a good sensory soothing. For me, it's like, I got, I think, a kind of a association of the sweatpants to this lifestyle of like retreating, isolation, not moving. And so, for me, there's an association there that I'm working to break. But for someone else, that might not be there.
PATRICK CASALE: For sure, absolutely. I agree 100%. So, these three, the things you mentioned, tying it all together, these feel like when we're creating these goals, right? We talked about this last time. We want these to be attainable. We want these to be realistic. These are things that we can feel confident in moving towards. So, do you feel that way with the stuff that you're writing down?
MEGAN NEFF: I do. Like, with the… and partly, so with the gut issues, again, I've suspected I've had gut issues for a long time, but I fell into an all-or-nothing mindset because when you're addressing this it's best if you can, like, avoid sugar. And I realized, like, I have a number of supplements I'm using now. I realized, like, I just need to not fall into the all-or-nothing thinking.
So, with all of these, these are very kind of and or. So, I still do have my [INDISCERNIBLE 00:32:16] in the afternoon, which I know I probably shouldn't, but it's like, that's such a soothing thing for me that I make at home, and like, it's got some sugar in it. But I found an in-between place and sidestep the all-or-nothing thinking that was like, once I can cut sugar then I can address my gut issues.
Same thing with work. It's like, okay, I can set up one guardrail, 9:00 AM. I don't have to address all my workaholism at once.
PATRICK CASALE: Exactly.
MEGAN NEFF: With socializing it's like, okay, I can get out of my sweatpants a couple days a week. So, I have found a way to sidestep my mindset which tends to be more of an all or nothing one.
PATRICK CASALE: For sure. And I think mine as well. And a lot of autistic people's mindsets in some ways, when we talk about black and white thinking, I almost look at this as, like, harm reduction from an addiction standpoint lens, too. Like, if I was trying to stop drinking alcohol and I said I'm going to stop drinking for 30 days, and then you have a drink five days in, you immediately destroy yourself mentally, "I can't do it. This isn't possible." You kind of almost go into self-sabotage mode. Like, "Fuck it. I'm just going to keep doing this."
But if I said I'm going to drink one day less than I typically do, or I'm going to go out less than I do on a weekly basis, it becomes much more attainable. And I think that's what we're looking for, is like that, attainability and the realistic viewpoint of what can we actually accomplish without, like, setting ourselves up for self-sabotage.
MEGAN NEFF: Yeah, yeah, yeah, exactly. And that's the, like, I think we're going to have an episode where we're talking about agency a little bit more, but that's that part about like, agency because when we fall into the all or nothing. It's like, oh, my goodness, I failed again. Oh, I can't do this. Yeah.
And like, I've tried things where I'm like, I'm going to move every day. I'm not going to have sugar. Like, I actually think after the episode we recorded with you, like, those were my goals. And it's like, "Okay, those are great. It's also like, not going to happen right now."
PATRICK CASALE: Right. I think we even said in that episode, which was probably about a month ago, month and a half ago, we're going to text each other accountability every day.
MEGAN NEFF: We did that for like a week.
PATRICK CASALE: We did that for a week, but that's what I mean. So, like, when you're listening to this at home, we really want to set attainable goals that feel realistic. We don't want our goals to be all or nothing, unless they have to be all or nothing, unless they are, like, life-threatening all-or-nothing situations. Like, make them attainable, make them easily accessible, make them really realistic because it does give you some psychological motivation when we are moving towards these things one little step at a time.
MEGAN NEFF: I think the other thing I would add is when possible to choose like a cornerstone habit. So, cornerstone habit, Charles, I don't know how to say his last name, Duhigg, I think, wrote a book on habits. And one of the things he talks about that's always stuck with me is like, not all habits are created equal in the sense that there's some cornerstone ones. His example is making the bed. I don't make my bed. So, I can't really relate to that. But it's the idea that a cornerstone habit is one where, like, when you do it, it sets up a positive domino effect.
So, like for me, I do think getting out of my sweat pants and, like getting dressed in more like non-sweatpants clothes, I think that's a cornerstone, maybe not habit, but like a cornerstone pattern for me, where if I do that it's going to lead to other things. Or if I don't let myself work till 9:00 AM it might mean I'll sleep more. Or maybe I'll use my mornings for something more restorative. So, I'm also choosing both things that feel doable, but also, things that are likely to be like a cornerstone practice that has a ripple effect.
PATRICK CASALE: Yeah, absolutely, agreed. I think that's fantastic advice as well. So, as we're writing these goals down, as we're, like, examining this, how are you experiencing this comparatively to writing all of this last night?
MEGAN NEFF: I mean, it feels better than, like, last night, when I was looking at this, maybe partly because there's, like, it's happening in a relational field. I'm not alone with all of this. But also, like, I feel cautiously optimistic about the protocol I'm on with supplementation. I feel cautiously optimistic that I can actually sort out a more healthy relationship to work. And I have had more energy since realizing like I should get out of my sweatpants more. And so, I feel like these three goals feel doable, and I think they will, like, push a few things in the right direction. I still have to figure out how to, like, actually address this grief and regret and that feels a little bit overwhelming, but like, I'll get to that. I'll get to that.
PATRICK CASALE: Yeah, that is certainly one that I can check in on you with, if that's something you want or…
MEGAN NEFF: No, don't it's-
PATRICK CASALE: [CROSSTALK 00:37:41]-
MEGAN NEFF: …good. Like, the OCD series, like, "No. I don't really want that."
PATRICK CASALE: I'll just put it in the back of my mind. I'll pin it. But yeah, I mean, this is daunting when we look at it all together in one image, and we recognize, like, everything ties into everything. But I think that's the real point of this exercise. So, if you're following along at home, you can certainly create your own biopsychosocial and there are lots of templates online for something like this, or if you're a visual person, and you can draw circles, then you can just create the same thing that Megan has created. I cannot do that. So, I do think this is helpful, though. Like, my sleep situation, despite some travel in between when we recorded has actually been significantly better. And-
MEGAN NEFF: Really?
PATRICK CASALE: Yeah, it's been really good. And I'm, you know, hate even saying that out loud because I believe that I'm going to jinx it. However, I've been falling asleep like I'm still waking up. I don't think I'll ever be someone who sleeps straight through a night. That just doesn't feel realistic. But I am falling asleep, I am getting at least, like, four hours of sleep at night. And as of right now, that does feel like a win instead of like 20 days in a row of just not being able to fall asleep and waking up pretty quickly.
MEGAN NEFF: That was so wild. Yeah, yeah. What do you attribute the shift to?
PATRICK CASALE: So, looking back at it, one, I do think all the travel, like all the jet lag, all the transition back and forth for that, like, five-month period where I was in bouncing back and forth from like Europe to the States, over and over and over again. I think that played a major, major role because my body would acclimate, my circadian rhythm would acclimate, and then all of a sudden I'd be back six hours behind or six hours ahead. And that definitely was impactful.
I also had stopped cold turkey, which I don't recommend anyone do, a Gabapentin prescription that I was on for like three years, and then I started noticing, like, the increase in the leg symptoms that I was experiencing. Then I went to my doctor, and she, like, upped the dosage to the maximum dosage, and I have not really had those leg issues since that time.
MEGAN NEFF: Are you serious?
PATRICK CASALE: Yeah.
MEGAN NEFF: That's amazing.
PATRICK CASALE: Yeah. So, I think advocacy for what we need too. Like, I was a bit embarrassed to go in and say, "I cold turkey stopped this prescription." Which I know better than to do, and then to be like, "But can we try this thing? And I think this is, like, a last resort situation, if we can see if this will help." And it did. I mean, I'm still experiencing it, but like, probably a 90% reduction in terms of discomfort.
MEGAN NEFF: That's huge.
PATRICK CASALE: Yeah.
MEGAN NEFF: Yeah. And I love how you name that. Like, you had to get over your own embarrassment to be able to self-advocate for, like, actually, I think this would be helpful, yeah.
PATRICK CASALE: Yeah. No more mental health professionals. And then, again, going back to what you said about, like, giving advice and offering suggestions, I'm like, yeah, don't cold turkey stop your mental health prescriptions. It's just not, again, [INDISCERNIBLE 00:40:57] situation, so…
MEGAN NEFF: Yeah, yeah.
PATRICK CASALE: Lesson learned, lesson learned. But yeah, I feel good about this. If you need any accountability in any part of this, I'm here to do that for probably a week before then our lives get chaotic and we forget. But I am glad that you are taking these steps on these things, and obviously, as a friend, I want to see you feel better in all of these areas. And I know it's been a struggle, so…
MEGAN NEFF: Well. Thank you. Yeah, yeah. And I like the idea. I think we had talked when we recorded your episode, of like, maybe we'll do a check-in in six months.
PATRICK CASALE: Yeah.
MEGAN NEFF: And like, let folks know. Yeah, it is interesting. I do feel like a little bit of a vulnerability hangover now. Did you feel that after we did your episode?
PATRICK CASALE: Yeah, I told you on air. I thought it felt like I was in therapy. I was like, "I just feel like I was in a therapy session for an hour, like going over this, like, intense and vulnerable stuff."
MEGAN NEFF: Yeah, I feel a little bit nervous about releasing this. I also know, like, a lot of people their lives intersect in similar, like have similar struggles. But, yeah.
PATRICK CASALE: Well, the good news is Megan that this episode's going to come out next week and-
MEGAN NEFF: Oh shit.
PATRICK CASALE: Well, you just can ignore the collab invites, and don't pay attention to social media, and it'll be out, and in the world, and then, it'll be gone.
MEGAN NEFF: Yeah, can I maybe review the reels like this time before?
PATRICK CASALE: Sure, yeah, absolutely, absolutely. You can always review the reels.
MEGAN NEFF: Okay.
PATRICK CASALE: Good news for everyone listening is that we are having a repeat guest on, will be on our next episode, Dr. Mel Hauser, probably one of my favorite episodes that we've done, probably one of my favorite interviews that we've done. I actually hired them to come speak to my group practice about neuroimmune systems and all the things. And it was just an incredible human being and resource. And I'm really looking forward to that conversation.
MEGAN NEFF: I am too. I'm really excited that they're coming back. Yeah.
PATRICK CASALE: Yeah. So, for those of you struggling with any of this chronic health stuff, we're here with you. We experience it too, and we definitely understand the complexity and the struggle. And I hope that this series has been helpful, if not depressing all of the time. I hope there was some optimism and glimmer of hope sprinkled in throughout, and you'll get a lot from this episode and Dr. Hauser's episode before we then transition into our OCD series that we are currently recording. So, anything else on your mind right now?
MEGAN NEFF: No, I don't think so.
PATRICK CASALE: Right. For everyone listening to Divergent Conversations, new episodes are out on Fridays on all major platforms and YouTube. Follow our Instagram, Divergent Conversations. Like, download, subscribe, and share. Goodbye.
