The Hidden Tax on Neurodivergent Professionals

[00:00:00] Rachel: It often takes a different source of brain to become a doctor or work in healthcare. High pressure, lots of exams, working unsociable hours on very little sleep. But often people whose brains work differently becomes so good at masking their differences that they ignore their own needs or suppress their feelings. This can lead to them asking why am I finding it so difficult when everyone else seems to be coping?

[00:00:24] Rachel: This week I’m joined by Dr. Lee David, a GP and therapist who specializes in supporting healthcare professionals with their mental health. Today we’re talking about the often invisible costs that come with the superpowers of neurodivergence, how organizations can make space for differing needs and different people, and ways to support whether your own needs are being met, or you are just trying to keep calm and carry on.

[00:00:49] Rachel: Now, this episode will be for you whether or not you have a Neurodivergence diagnosis. I think all of us to some extent ignore our own needs in the face of other people not needing the same as us, and it’s something I’ve been thinking a lot about recently. So I find this chat with Lee really eyeopening. Whether you are neuro aversion yourself or you think you might be, or you are working with team members who are, and if you have any particular experiences you’d like to share, I’d love to hear from you. Just contact us at hello@youarenotafrog.com.

[00:01:22] Rachel: If you’re in a high stress, high stakes, still blank medicine, and you’re feeling stressed or overwhelmed, burning out or getting out are not your only options. I’m Dr. Rachel Morris, and welcome to You Are Not a Frog.

[00:01:39] Lee: I’m Dr. Lee David, I’m a GP, CBT therapist and EMDR therapist. Um, I work as a clinician and therapist at Practitioner Health, uh, supporting clinicians and health professionals with mental health challenges. I’m also the mental health lead at Red Whale, an education company.

[00:01:59] Lee: I am also an author. I’ve written several books for, I’ve written some for health professionals about self-care and also for, for young people about managing low mood, anxiety and body image concerns. And I’m a podcast host myself at the Choice Based podcast.

[00:02:14] Rachel: So, Lee, it’s brilliant to have you back on the podcast ’cause you’ve been here before. We are talking today about burnout as you know what the topic I talk about a lot, but it’s more than just burnout. Um, but I’d like to start off with asking you in your role as mental health, you know, practitioner supporting people at Practitioner Health, you see a lot of doctors who are coming to you with, with burnout.

[00:02:37] Rachel: And my observation is that a lot of doctors don’t know their burning out until it’s too late and they’ve gone off that cliff. And I don’t think it’s just, we’re sort of ignoring the signs. I think sometimes we genuinely don’t recognize it.

[00:02:51] Lee: Yes, it, it can definitely be true. Um, and I think there’s lots of different reasons for that. I think. As, as doctors, we are encouraged culturally to, to just keep pushing on. It’s, it’s that thing of just keep going. And so that I think, mirrors a lot of personality traits that bring us into medicine in the first place. It’s that ability to work really hard to push through.

[00:03:14] Lee: And I, I think there’s a culture that I often talk about in therapy is, is kind of push on and ignore how you’re feeling and just get the job done. And I think that is very functional for, for medicine. It encourages people to be a good colleague, to work hard to, and you get a lot of positive uh, perspective from others about that. But it also is the ignore part is where the problem comes in because we are used to shutting down our needs, not recognizing them.

[00:03:40] Lee: The other thing that I think can play into that is if we are starting to think about neurodiversity, then I, I think it’s some individuals within medicine who may be neurodivergent or have some traits, neurodivergent traits may well also have something like alexithymia where it’s more difficult to pick up on emotions until they kind of get hit in the face. So it’s kind of, I’m okay, I’m okay. I’m okay. Wham, I’m really not. Okay, I’m over. I’m at the bottom of that burnout cliff.

[00:04:09] Rachel: Okay, so there’s this, these cultural things that, like we’ve been, we’ve been built to ignore our own needs. And I also think that, you know, people like doctors, like you know, senior, other senior healthcare professionals in high stress, high stakes jobs can genuinely tolerate quite a lot of pressure. And that’s almost why we went into the job.

[00:04:27] Rachel: But that ability to tolerate a lot of pressure, is that a, a natural skill or is that a skill that comes because, and this is one of my theories, you probably have to be a little bit potentially neurodivergent to be in this job in the first place.

[00:04:44] Lee: It is. I mean, what I would say is I definitely see that personality traits that are selected for in medicine and in, and in high pressure roles generally, you know, the ability to be able to work harder on social hours, to be able to cope with really quite high level of decision making under a lot of pressure.

[00:05:05] Lee: Um, and so, you know, to some degree, if you are working in a high stakes environment, needing to make decisions very quickly under pressure, so I’ve done a lot of work with example, anesthetists or you know, where things are very, where you need to be responsive very quickly and you need to be able to engage and think clearly, follow protocols, bring up your knowledge and experience, then really, managing your emotions at the same time can be very challenging at that point, because they can become, they, they, they, they can distract from getting on with the job.

[00:05:40] Lee: The problem is, is I think there’s a, there’s a, there’s a level at which emotions can be suppressed. And then the more intense they get, the more difficult it becomes to do that. And actually you have to put effort into trying to suppress your emotions. That actually becomes more of a distraction than the emotion themselves.

[00:05:56] Lee: And I, when the people I see, it’s often come to the point where it has built up that level of, of stress, that chronic underlying distress, um, feeling under pressure, maybe there’s an inner critic, there’s a sense of knot of it being harder than it should be. And that just builds up and up and up to the point where actually that is now a much bigger distraction than the original emotion. So it becomes, we’re stressed about feeling stressed, about feeling stressed as a sort of layering problem.

[00:06:26] Rachel: So you’ve got these, this sort of suppression of emotions because either we’ve been taught to do that, or maybe the way that our brains work means that actually it’s quite difficult for us, for us to recognize our emotions in the first place. And so we just keep doing what we’ve just always known we need to do, which is work harder and harder and harder and keep going under pressure even when everyone else is, is dropping off and saying that they can’t cope.

[00:06:52] Rachel: We also, I think, end up rescuing other people, so when other people can’t cope, we had this absolute sense of, of duty. It’s interesting, we did a masterclass last night and I sort of asked, what, what stops you saying no or for accepting the stuff outside your control? And someone just wrote the chat duty. I thought, gosh, that absolutely pinpoints it. This sense of duty we feel to our colleagues and to our patients, but not to ourselves.

[00:07:17] Lee: Well, I could, I could honestly talk, we could do a whole podcast separately on the, on the issue of duty because that is one that comes up. I see that all the time. And, um, and we can maybe think about how you might balance that out, looking at that urge for, for, you know, it is a lovely quality, isn’t it? Wanting to be professional, wanting to show up for our colleagues, wanting to be good at our jobs. And so we don’t have to eliminate that.

[00:07:40] Lee: But it is about ing it because there’s a limit to how helpful it can be and for how long. And so we want to be able to show up and be professional, but we can’t do it at the expense of other parts of our lives.

[00:07:51] Lee: So I don’t see them as competitive. I see them as it is just a question of recognizing that both care for ourself is one of our needs and we want to be a, a, a professional that we can feel proud to be. And, and those two things can coexist and it’s trying to recognize that they both have, have value.

[00:08:10] Rachel: And so in your work, particularly with Practitioner Health, when you are, um, seeing doctors who have experienced burnout or, or have just fallen off that cliff, are there any other reasons why they may not have noticed things getting worse for a while, or they may have noticed and not done anything about it?

[00:08:28] Lee: Well, I, I do think, we mentioned a little bit earlier about neurodivergence and I think the idea about being of, of alexothymia is something that people, um, may be aware of or may not be.

[00:08:38] Rachel: Yeah, can you just define

[00:08:39] Lee: Yes. So, and I don’t know, I, I, it, it, my personal definition is, is that it’s harder to connect with emotions and sometimes body sensation. So it, it is, can be more difficult to label them. It may be more just less aware of them, perhaps as we’re going along and perhaps just in general terms. And, and it is very variable for different people how it may show up, so I try not to be too overgeneralizing.

[00:09:07] Lee: But it can, the, the, the consequence is that it can mean that it can be harder to recognize how we’re feeling. And therefore it’s harder to respond to it helpfully at an early stage. And particularly when the feelings are building, then there may be maybe far less awareness. And, and when I’ve been working with a number of neurodivergent individuals through Practitioner Health with, with clinicians, then that often becomes one of the pieces that we’re weaving together, which is okay if, if it is hard to, to pick up, that’s okay, that’s just, you know, that might be a neurodevelopmental difference. That isn’t something that therapy is going to necessarily change. But what we can do is look at how do we work with that in order to maintain our wellbeing, if that’s who we are.

[00:09:58] Lee: And, and I talk a lot about neutral acceptance, which is about, it’s about recognizing ourselves in a kind of neutral way. It’s not necessarily about, oh, I’m so great, but it is, these are my two, you know, this is who I am. Um, these are the things that impact me whether I want them to or not, these are my, some of my personality traits. Um, and, and so we can then work with that in a, in a helpful way.

[00:10:20] Lee: I think what we, I do see is that in, we often see in the kind of neurodiversity piece is, is seeing that whole range of human spectrum, of different ways, of brains being wired, and just seeing that that’s all part of the normal range. There is, it is not about, it’s about difference, um, rather than disorder. And I really like that as an idea, and you can then bring that in.

[00:10:44] Lee: Because a lot of the people I see, some may have a, a, a, a diagnostic category of neurodivergence, like, I’m autistic, or I have a DH adhd, I’m dyslexic. Many I see don’t. Um, some may decide to go for a diagnosis, some may not. Um, others may just not really want to go there. And there’s a sense of maybe there’s some stigma or there’s personal reasons why. It’s just not an area they’re wanting to, to explore. Um, so we really have to have quite a holistic approach to managing needs in an quite an inclusive way that means that it, it covers all the different needs that people might present with or as well as neurotypical people.

[00:11:26] Rachel: I, I guess I hadn’t really got that before that often, and particularly with neurodivergent people, it’s not that you are ignoring the signs of burnout, it’s you don’t, even though you’ve got them sometimes, because you’ve got this sort of whole mush of emotion. Is it that people don’t actually feel emotions? Or is it that they do feel them, but they put them down to something else?

[00:11:47] Lee: I think that’s really variable and it’s something that you might explore with that person. And it’s like, what, what do I notice? Sometimes you might notice a body sensation. Sometimes I’ve got people, where we work on trying to find what can I notice that’s a sign that I’m starting to feel stress and, and it might be something like, oh, I’m actually starting to clench my jaw, for example. And so it might be a body sensation.

[00:12:10] Lee: Sometimes body sensations are, are not necessarily noticed, so people can have really high pain. I’ve got people who’ve got really Pia high pain thresholds that I’ve worked with where again, there’s just not that awareness of pain until it’s really quite significant. Um, and so it really varies about what that shows up for.

[00:12:30] Lee: But it, what it means is that people need to be more able to predict over time, I think this feels helpful for me. And, and, and it might be that you need to cognitively plan. So this type of scenario is one where I can predict it’s likely to build into stress over time. So actually I’m not gonna wait till I start to feel stress. I’m not even gonna look for signs of stress. I’m going to take action way before any kind of stress shows up. Because actually that it may well be that there are signs, but they’re harder to pick up. So in fact, it’s, it’s really going upstream and looking quite creatively about what do I need to put in place?

[00:13:08] Rachel: And just with this emotion thing you said they might notice stuff in their jaw or, or whatever. Does that mean that people with alexothymia might not notice that they’re tired or hungry or some of those other basic needs as well?

[00:13:20] Lee: Oh, a hundred percent, yes, absolutely. So, you know, don’t need notice, a need to go to the loo which we all, I think we can all recognize that, that we’ve, we’ve not been to the loo until we are verging on our bladder feeling completely, you know, full to bursting.

[00:13:35] Lee: And so, you know, you can see how that then contributes to the burnout pathway because we then ignore, we’re not, you know, the, the, the Maslow’s hierarchy of needs is we need to be fed, we need to be rested, we need to have to, we need to have drunk enough fluids, um, and all of those things. And if they’re not in place, because, partly because we’re busy. So it’s the compounding factor of being super busy and not having time to think about it, and perhaps less awareness. And I think those two things together then mean that people are just not addressing them in, in a timely way.

[00:14:09] Rachel: Um, we’re talking about people, you know, maybe with, who do think differently with neuro neurodivergence, um, falling off that burnout cliff before they’ve even recognized it. Is there anything else in the whole spectrum of neurodivergence that actually means that they’re perhaps more prone to burnout in the first place?

[00:14:27] Lee: Yeah, so I think there’s, there’s a whole range of, of of reasons, you know, so masking is quite significantly linked. We know that neurodivergent clinicians have higher rates of anxiety, depression, trauma, and burnout. So the, the, the, the risk of mental health conditions as a consequence of living with neurodivergence is very significant, so it’s really important to recognize that.

[00:14:53] Lee: And as a therapist, my role is, is to work with the mental health aspect. It’s not to, to look at and to, to encourage people to, to find ways to look after themselves as a neurodivergent person. So it’s kind of neuro inclusive, neuro informed therapy. Um, it is not about working with the neurodivergent traits per se. It’s about making room for them and working out how best to live your life in a way that actually supports you. And I think that is a, a big shift, that it’s important.

[00:15:22] Lee: But I think the key is then, um, masking, which is about trying to appear more neurotypical, which is like the swan analogy, where on the surface you may look completely competent and capable, and then on the surface it’s just taking far more work in order to maintain that. And so it just has this under the surface impact where it depletes people’s resources because they’re constantly having to put away a whole lot of effort into maintaining that.

[00:15:53] Lee: And there may be situations where they find it harder to do it, and there’s awareness of that as well. And that feels, and it feels like there’s a shame sense. I, you know, I, oh, I didn’t, that meeting went, didn’t go well and I’m not quite sure why. And actually, I feel really bad about it now. And why can’t you be more like other, like the critical voice? Why is this so hard for you, um, and other people? Why do other people, why can’t you do your appraisal? You know, with my ADHD clinicians, why is you taking you so long to do it? And no one else is doing that? So we have this judgment against everyone else who, who we imagine are doing it really well.

[00:16:25] Rachel: that, that example of the appraisal, I can a hundred percent, you know, empathize with that, you know, my appraisal, I was like, oh, right, you’ve gotta document it now. Document it now, just get it done. Never did. And then, you know, you, you’re up till three in the morning the night before going, why didn’t I do this before you idiot? You idiot. You shouldn’t have done it. And, um, just that, that organization thing.

[00:16:42] Rachel: What other examples have you got of, of masking? One that might come into mind for me is like, if you’re an extreme in introvert, is, would, would a masking example be that if there’s a coffee break, you, you, you go and you have coffee with a whole group of people and act really try and act more sociable, when actually what you need to do is sit on your own to, to recharge and replace it. Is that an example of masking or not

[00:17:05] Lee: And well, what I would say is it can be, um, and so what I would do is try and really drill down. Um, and this is where I would look at, well, I think that it, it is, there’s a sort of gray area between do I want to go to the coffee break? Do I, how important is it to me? Um, versus I feel forced to go.

[00:17:25] Lee: So I’ll give another example of this is of thinking about what this is where I would come back to, needs the individual needs and weighing them up. Um, so if you are, if you’re thinking about that coffee break example, then you might have, you know, even as someone who’s quite an introvert, you may still have a wish to connect with colleagues and in an informal way, or maybe you don’t. Um, so it is trying to work out how important is it to me to connect with colleagues? And if it’s important, what would be the most effective ways for me to do that, that don’t take the, the, the most toll to do it?

[00:18:01] Lee: So you might then think, well, I’m gonna go for a coffee break when I know there won’t be so many people there. Or I’ll, I’ll, I’ll just buddy up and go when my friend is gonna be there, and that makes it easier. So I know I can chat to one person who feels safe. And so it’s looking at the wider range of, well, I, I, I need to do self care, I need to protect the part of me that gets exhausted in social contact, but I don’t want to, there’s sometimes there’s a pendulum where people then swing the other way and avoid things, which actually means that part of their, their needs are not being met.

[00:18:35] Lee: Um, and, and so another example might be if you are asked to do, to work an extra shift, um, should you say yes or should you say no? And for me what’s really key is what is underpinning the decision. So if it’s a very negative, you have to say yes. If you don’t, everyone’s gonna think you are bad, you are lazy. Um, you’ve got no choice. Just ignore how you feel. I know you are tired, but forget you don’t matter, you matter less than everyone else, so just get into work and push through, then that is very likely to lead to a negative kind of psychological toll.

[00:19:10] Lee: If we can say. Hmm. How am I doing this week? I, I, I do genuinely care about my colleagues and, you know, if I’ve got the resources, I would, I would want to contribute to the team. The team matters to me. So I’ve got a, a value around teamwork and contribution. Um, but I also know that I need to look after myself. So let me think about my other priorities, let me look at my schedule, let me see if I can fit it in, and if it feels like a good choice, then I’ll do it, but I won’t automatically do it if I think it’s going to take a toll or harm me.

[00:19:42] Lee: So it becomes, it is not like I should never go to the coffee room, or I should always do anything as much as I need to weigh it up and think about all the competing needs. And I think what can often happen is that one part becomes very loud. So it may be that if we’re in a stress. Sort of situation. And I, what I see a lot of is that doctors cope with stress by working. So they, their coping strategy for stress is to work more because it’s kind of quite easy. Like you get quick wins, you know, you do your job and you get something ticked off and it feels quite productive and people are grateful. So it’s, it becomes a coping strategy. And so if it’s just like your automatic go-to coping strategy, unfortunately that builds up to a risk of burnout over time.

[00:20:26] Lee: And so we’re wanting to bring it all back to choice about, is this helpful for me this week? Is it helpful for me today? Versus blanket rules, I should always behave in a certain way.

[00:20:38] Rachel: But how do you know if activities are taking their emotional toll? If it’s very difficult to work out our emotions and how we are feeling, then how do you actually know that’s, that’s, that’s even more difficult to do.

[00:20:50] Lee: Yeah, so I, I think that comes back to needing to take some time. So if you think about sort of the emotional, your, your sort of barometer of emotions when emotions are high, you know, when, if you had a, if you rated them from nought to 10, if emotions are 6, 7, 8, then you are, you, you know, I, you are often talking about the threat brain and, and our threat brain becomes very loud and we’re kind of mostly viewing the world through our amygdala. And everything’s about threat and everything’s about fight, flight, freeze, or flap is the other. Well, I get a bit flappy,

[00:21:22] Rachel: Oh, that’s another

[00:21:23] Rachel: one.

[00:21:24] Rachel: that’s five.

[00:21:25] Lee: Well I have made up the last two. I

[00:21:27] Rachel: I’ve, but I like that

[00:21:29] Lee: Well, because it’s like I need to, you know, and it’s a coping strategy that is quite common, so I like to talk about it because there is definitely a group of people who do slip into that kind of flappy approach. And so when we’re, it is like the monitor of the threat brain is very loud and our prefrontal cortex and all our wisdom and, and it’s like turning down the brightness on your phone. It’s just not as, you’re just not as connected with that.

[00:21:54] Lee: And so when it comes back to thinking about what’s right for me, when emotions are higher, then immediately we have lost touch with the prefrontal cortex, which is where that kind of thinking has to take place. So by definition, we need to be doing it at a time that we’re feeling safe, that we’re feeling, um, soothed, that we’re feeling connected, that we’re not feeling overwhelmed, that we’re not just recovering from a horrendous day at work and, and still managing that.

[00:22:23] Lee: So we need to get into a space where we’re feeling better, and that’s why I often don’t do that till a little bit later on in therapy, because actually when people come in and they’re really activated and stressed, then that isn’t the time to start to start doing that.

[00:22:37] Lee: But I would often do some imagery around this idea. So I might say to people what kind of place would you be at your best in terms of thinking about who you wanna be or where you wanna be? What would be a really lovely space for you to be? Um, and I fi find that being somewhere really helps. So maybe it’s being sat in your garden. I’ve had people choose being on the mountain skiing, doing an act, sometimes doing an activity. Ima even in imagination, is great. ’cause it sort of takes that, it makes you feel like you’re moving and it, it sort of reduces some of that in, it just loosens up.

[00:23:10] Lee: I think there’s, there’s evidence that people are not, there’s more neuro to plasticity when we move. So some kind of moving, maybe imagine themselves doing some yoga or sitting in a yoga studio, um, or looking out to see. So there’s lots of places that we might choose and then we do some imaginal about, okay, if we sat there, what does the mountain tell you? What, what does the garden think might be useful for you? And, and what, what advice would they have to you about how to navigate this situation?

[00:23:36] Lee: And I find, I found that the, the garden and the mountain are very, actually, very good at coming up with some really amazing answers. Quite often it is, it is really interesting.

[00:23:47] Rachel: It’s so interesting ’cause we know deep down we do know what we need. We know when we are at our best. We know when our energy is depleted. We know what, you know, builds us up. We know what re-energizes us. But the alternative voice of, well, you’re not good enough or you should, or you ought to is so, so strong.

[00:24:08] Rachel: Do people with, who are neurodivergent, do they have a, a, some stronger voices like that? Are, are there any sort of typical things that people would say? I mean, I, I have a friend who’s quite severely dyslexic and I know she has a very internal voice telling her that she’s stupid, even though she’s one of the brightest people I know. But I think that’s from the past, you know, from her school when she felt stupid ’cause she couldn’t read as fast as other people and stuff like that.

[00:24:33] Rachel: Are there are other that these stories and voices that, that are particularly strong that you’ve noticed that, that the themes that come up, you know, because obviously you’ve seen so many different, different patients now you, you must be noticing a bit of a pattern, right.

[00:24:45] Lee: Yeah, I, I think it’s, it, it’s a mixture of, of, of both patterns and also remembering that there’s, that, you know, the spiky profile, um, means that, um, so, and I think I see it a lot in neurodivergent clinicians, and this can contribute as well to how we mask so well is that we may be super functional in certain aspects. Um, so you may get a surgeon who’s just the most incredible skilled at surgery, but struggles with some of the interpersonal aspects of.

[00:25:15] Lee: And, and I think what can happen in medicine in particular is some of the tools are, are much more straightforward because it’s much clearer about, well this is my role as a clinician, I need to do this job, and it’s much more boundaried, versus some of the, the more nuances of how do you manage the complexities within the team and all the personalities, and these big meetings where everyone’s talking. And, and that is much, much harder than just being in theater, for example, uh, and operating or being the anesthetist and just when somebody’s fo you know, managing the complex situations clinically is, is often much easier than managing the complex situ, situ situations interpersonally.

[00:25:53] Lee: I think also I definitely agree, Rachel, there is a lot of stigma around it. And, and it often goes back, um, to when that person first started to become aware of some of those difficult areas. And I really like a past model for exploring our different experiences.

[00:26:11] Lee: And so part, often if we have anxiety, our, our anxiety is often is quite young. It’s often, we’ve often been anxious since we were like young children, you know. So our, our anxious part is, is almost like a, a young child often. Um, but the, the critic often develops roundabout adolescence because when we become an adolescent, we become much more socially aware. Um, there’s more pressure put on about achievement, and there’s much more social pressure as well around managing, you know, secondary school is a, is an area where it is really hard, isn’t it, for a lot of young people about managing those relationships.

[00:26:48] Lee: And so many people actually have started to develop that critical voice. Maybe they perceive that it is, uh, a lot harder for them, for like your friend who with dyslexia, so being dyslexic means that it’s harder for me to do something than others, and so I feel, does that mean that I’m stupid? And we get these beliefs that then have, have a toll.

[00:27:11] Lee: Sometimes in medicine, um, people get through school okay, because they’re, in fact, it’s not that hard because they’re so bright. And then when they get to medical school, it then becomes harder, you know? So it, it kind of depends at what point you are faced by something that suddenly feels wow, this is an ask that I don’t necessarily feel as resource to deal with.

[00:27:33] Lee: Um, sometimes it’s starting in work, so maybe the critical voice is actually really helpful for jumping through quite defined hoops. So having a bit of a kick up the backside can be quite functional for getting past exams. You know, it gets you through your medical school exams and it, it’s over, so it’s not a longitudinal thing. You get through the exam, hopefully you pass and then you move on. And, and maybe perhaps ADHD people didn’t pass and then there’s some shame around that. But sometimes we do pass.

[00:28:05] Lee: But then when we get into the workplace, these hoops don’t just end the demands are daily, they’re constant. There’s a constant pressure, a need to achieve and it’s, it doesn’t relax. And I think more and more the intensity have grown since. So I dunno about you, Rachel, but since I started medicine, I think the intensity is just so much higher. And so we’re, we’re on constant threat basically. And so that then becomes much more difficult because we can’t achieve it, have a bit of a wind down after the exam reset, because tomorrow it’s just as, as stressful as it was yesterday.

[00:28:40] Rachel: So it’s not necessarily that our, that we’ve got worse, worse in, in inverted commas, that our brains have become more neuro aversion or, or we can’t cope. Although I think there is something about menopause in, in women where your brain just goes, well, mine has, you know, lack of estrogen and blah, we’ve made things a lot worse.

[00:28:57] Rachel: But it’s not that we are getting worse. It’s actually that we could cope before, because you had the, the exams, then you could rest, then the exams and rest, whatever. But now when it’s just relentless, you don’t get that chance to, to, to reset and come back into yourself and, and be able to cope.

[00:29:13] Lee: Yeah. ’cause I mean, neurodivergence is just a thing, so I don’t think we, that can change, and it’s, that isn’t good or bad, it’s just how people are. And I, and I, I’m not convinced there’s evidence that that is changing. But I think the recognition of it is changing, and I think the impact of it is changing, because the toll is, is greater if the expectation is harder, if the hoops are higher, if the constant, stress is greater, that is likely to take a greater toll, on somebody who’s neurodivergent.

[00:29:43] Lee: So when we think about neuro inclusive workplaces, they are actually good for everybody. You know, things like a walking break, you know, movement breaks for people. Most of us function better when we’ve got up and had a bit of a move rather than trying to sit and concentrate for 12 hours without break. But if you have ADHD, then actually if you don’t get up and move, then you basically can’t function. And so it, it can spiral into a really challenging sort of, and, and so there’s a greater risk of, of behaviors to cope with the distress.

[00:30:15] Lee: And so then there’s also risk of, of other kind of masking behaviors, which might be leaning into alcohol, for example, or even drug use as a way of, of not experiencing the stress of having to live in a world that wasn’t built around my needs as a neurodivergent individual. So I think it’s this combination of increasing pressure and how that can have a differential impact on different people.

[00:30:39] Rachel: I was gonna ask you what, what other unhelpful coping strategies are. You’ve already mentioned the, the biggest one, which is I think, working harder. Like, I’m stressed, I can’t cope. Let’s just work harder, which is just when you think about it bonkers. Um, but then there are, you know, the drugs and alcohol thing and I, I very much identify with when things get really stressful, when I feel a bit overwhelmed, the easiest thing have a glass of wine, you know, it just sort of switches off that, that anxiety and the default and loads of us do that, I’m sure.

[00:31:07] Rachel: Not that helpful when, because then, then it tends, you know, if you’re using that, you’re gonna need more and more and more and, and stuff like that.

[00:31:14] Lee: Yeah. And just quickly about the alcohol, ’cause I think there’s something that I want to raise that’s much well before, ’cause people will often come and say, well, I’m drink, you know, and, and we have a culture of alcohol. Um, and so alcohol is perceived as exactly that, a kind of wind down strategy. And if we’re not drinking at Really excessive levels, then people kind of feel okay about it.

[00:31:38] Lee: Um, and what I would say is that I think alcohol, and I think there is evidence to back this up, that it impacts your processing, especially at night. So if you’re having alcohol at, at night, you know, when we’re asleep, things like the REM sleep, it’s repackaging all the stress. It’s, it’s doing something in our brains. And I don’t think we really know exactly what, but it’s, it’s dealing with stuff, it’s, it’s sorting out the library. If we’ve had a mishmash of books thrown on the floor, then it’s picking them up. It’s reordering them, it’s putting them into perspective. It’s linking them up with, with past, uh, experiences. So it’s finding books and putting ’em together into themes, which makes them more understandable. And so it, it improves our coping abilities because we’ve got more structure internally. And so we, and we have processed some of the often borderline traumatic, so maybe lo small T traumas.

[00:32:30] Lee: Um, so there’s big T trauma, which is obviously high levels of, of, of traumatic experience, which need genuine trauma therapy. And I, I, I do EMDR and other trauma therapies for that. But actually there’s a lot of things that can land as a trauma because they have just so distressing that they haven’t fully been processed. And I think neurodivergent individuals are more sensitive to that, where things can be experienced as a trauma.

[00:32:55] Lee: Um, and so working at ways to process those experiences is really important. And so avoidance of thinking about them is another thing that we, that people lean into. I’m just not gonna think about it. And, and the problem is, it’s, that’s back to the get hit by overwhelm because it’s building up in the background.

[00:33:15] Lee: But also alcohol steals our ability to process. And it’s quite insidious because you don’t really know it’s happening. And so it might not be that I’ve got genuinely a problem with alcohol per se, but it really is stopping me from dealing with my stress. And so it becomes a cycle where we may be more at risk of increasing, but either way it’s not helpful. So I would often couch it in those terms.

[00:33:37] Lee: And people are often quite surprised and, and much more likely to think about, oh, I do actually need to think about my alcohol. Um, not because I feel like I’m verging on being an alcoholic, which there’s a lot of shame about that as well. I mean, and not say that, you know, they shouldn’t be because it’s just another behavior that people are choosing to try and look after themselves. It’s just, it has consequences that are negative.

[00:33:57] Lee: So no shame. However, there’s, I see a big group of people who don’t. Necessarily align themselves with, with that kind of behavioral pattern. But it doesn’t mean that alcohol doesn’t have some, isn’t something to think about.

[00:34:10] Rachel: So there’s alcohol and there’s drugs, obviously. Um, are there any other insidious things that you, you see people are, are doing to cope that, that people might not recognize their coping strategies?

[00:34:21] Lee: Definitely. So one thing that I would see is a boom bust kind of pattern of beha of activity and sort of doing a lot, burning themselves out, um, and then feeling overwhelmed, exhausted, and then o resting as a coping strategy, sort of stopping. Um, and, and I would, I, I’m really in favor of the idea of restfulness rather than rest, per se, in order to counteract fatigue.

[00:34:51] Lee: Um, and it is about knowing where you’re at in that kind, you know, sometimes, and I think particularly say autistic burnout, people really do need to take time and they need to reduce demand massively and, and, and go down a lot. Um, for people who are on the, on the, perhaps the path to burnout, they haven’t reached it and it’s not full on recovery. It’s more like, how do I stop myself from falling off that cliff in the first place? Which is, which is really preferable because it, uh, you know, it can take a lot longer to come back up from the bottom of the cliff than to stop yourself falling down in the first place.

[00:35:23] Lee: Um, so boom, bust patterns, I think are often where people are quite high achievers, where they push themselves very hard. So for example, in relation to something like exercise, um, people then become quite perfectionist and they think, oh, I want to, you know, what’s the point in doing it unless I can run that half marathon at, at, at a high speed like I used to? Um, and, and if I can’t do that, then, and then it gets linked with kind of sense of, uh, failure or, or you know, not living up to perfectionist standards and, and a self-critical voice which kicks in. So you get that kind of triad.

[00:35:59] Lee: So what I would often see is that people use the threat drive. Um, they, they, so they have, they feel threat, which might be chronic stress and we cope with it using drive, um, which is, you know, the dopamine based act do, do stuff. And that is actually great, but it’s what kind of drive are we choosing? And if we’re just choosing either work as we’ve already said, or we are choosing kind of crazy heart, or not crazy, but difficult, high octane goals that are not really about nourishing and recharge, they’re about proving something about to yourself or about yourself, proving that you are good enough.

[00:36:37] Lee: Um, as soon as something is motivated by like proving that I’m good enough, then it’s likely that that’s gonna stray into some kind of unhelpful territory in my book. So it comes back to trying to plan much more realistic goals that are maybe, you know, process based goals or maybe looking at wider values. Like, my wider value is I want to look after myself. I want to find a space to recharge. I want to move in a healthy way that supports my wellbeing, and I don’t want to exhaust myself. And maybe it’s harder for me to notice when that’s happened. So actually I need to immediately turn down my expectations. I might think that I could do a seven, but actually I should just be aiming for five out of 10 in terms of intensity or length. Maybe it’s going for a walk for 10 minutes, and if I feel okay, I’ll, I’ll extend it, maybe it’s.

[00:37:25] Lee: I, I like to talk, I go running in the mornings. And that, and I go quite early because it just gets it out of my way. But I’m a great believer in being a really bad runner, like running really slowly and just plotting and if necessary, walking and chatting whilst I go and, and not, and the goal is just to have been, I I, I don’t even measure my time anymore. I, or the distance. I just want to have moved in some way and that, that sets me up for the day and I found that really helps.

[00:37:50] Lee: So it’s working out for this individual, what does that look like, where we can try to reduce that pressure of the achievement just being something that drains us even more.

[00:38:02] Rachel: I, I, I often think that, you know, doctors, we pursue leisure, don’t we? Like you said, you know, half marathon, I’m gonna go, go to ever a space camp. I’m gonna do this and that. And like that is not rest. Yes, it’s not work, but it, it’s definitely not, not rest. And we can get a bit obsessive about that as well.

[00:38:17] Rachel: And I love the, you know, you, you are aiming to be a bad runner. I, I’m aiming to be a really mediocre tennis player, but I do find myself on occasions when I’m playing badly, getting really stressed by it and then beating myself up. I’m like, well, how is that? How is that resting? But resting feels somehow like you are, I dunno, cheating or I think a lot of doctors feel that they have to earn their rest.

[00:38:40] Rachel: Um, I’ve only very recently realized that for me with ADHD, I need rest that isn’t doing anything, but is also slightly stimulating my brain. It’s very weird. I couldn’t just sit on the sofa watching TV that would, well, I can in the evenings when I like if I, you know, I’ve got into a good box set. But lying in a sauna is brilliant because, uh, you’ve got, you’ve got the heat and you’ve got the thing, and that’s where my mind can, like, solve problems and stuff. Or, you know, pottering around the garden that is, that is great rest. But if I then set myself a target to do stuff, because the problem with ADHD is you, you just onto the next thing you know.

[00:39:15] Rachel: I, I would, if I could just sit and devise courses all day and read books on this and how to do that, ’cause I find it really interesting, but that’s not really resting. And then you do, you get this, this boom or bust thing. So either you’re like circling the drain of burnout, you go down a bit and you come back up and you go down a bit, come back up. Or you are only plugging your cha your battery in and you’re waiting until you’ve charged that to like 40% and then you think you’re ready to go. That’s, that’s what I, I see myself and I see in, in a lot of people.

[00:39:44] Lee: Yeah. Um, uh, so, and I think, I think if you are plugging in, if you are, uh, you know, 20%, then actually the difference between 20 and 25 is actually quite significant. So it is okay, but you need to do it more than once. So you can’t then plug it in for five and get up 5% and think, well, that’s me done for the week, I don’t need to charge. Why is my phone run out of charge?

[00:40:06] Lee: So we need to do, I like to think about micro fills. Um, and I, I do a very similar analogy of like petrol. Like you might go to the petrol station and just fill up with even just a very small amount. But if you go regularly to the petrol station, then actually that does lead, and, and if you are able to get up to maybe half or a little bit above half, we can probably be at a functional level there. So you don’t need to feel like you’re failing if you’re not on 90%, because I think that is actually unachievable for a lot of people. But the goal is probably maybe 60 plus. Um, but actually. If we’re below 50, then it’s likely that we’re, we, we need to do a few top ups, but they don’t all have to be done at once.

[00:40:46] Lee: So it’s giving ourselves permission to do these micro tolls that, you know, otherwise it’s like driving up a big hill when your petrol is on empty flooring the engine and wondering why there’s smoke coming out and shouting at the car with a critic. Why are you driving faster you stupid car? What’s wrong with you? And it, and that’s what we do to ourselves.

[00:41:06] Lee: But you know, the poor old car probably needs to go to the garage. It needs an oil change, it needs some petrol. Maybe it needs a clean, you know, there’s a whole load of things that that we need to do that mean that the car is then able to function as this vehicle for getting us navigating round our lives.

[00:41:22] Rachel: Yeah. That’s a brilliant, brilliant analogy.

[00:41:25] Rachel: Lee, are there any other useful questions that you should be asking yourself? I love the, when you talked about going and you, when in your therapy sessions you get them to go to a, a space like skiing or on a mountain or a nature, you know, and asking the garden, what, what do I need? What other questions do you ask your, um, clients to help uncover what they really need? Because I, it, I think this is one of the most difficult things that doctors, whether you are neurodivergent or not, I don’t think we ever really know particularly what we need.

[00:41:59] Lee: Yeah. So I would be encouraging people to start to just spot their needs a little bit, even if it’s just occasionally, um, oh, I’m thirsty. Oh, I’m hungry. And, and trying to not wait and to be linked and to align not to, I’m gonna wait. We know that if you wait till you are thirsty, you are already dehydrated anyway. So that applies to most things, that you don’t wait until you feel it in order to act on it. But when we’ve got a bit of time, we can sit back and, and, and reflect.

[00:42:30] Lee: The, the thing that I do, probably a lot of is asking who’s showing up at the moment, like which part of you is showing up and what is it that they want, um, and what and how are they trying to help and how are they trying to achieve it? And what are the helpful aspects of that approach, and what are the unhelpful aspects of that approach?

[00:42:52] Lee: So for example, if we go back to the exercise and the, I should be able to run this half marathon, and, and then you go out for a ru and, you know, uh, maybe you look at your step count and it’s only 3000 today and you know, your goal is 10,000, then you feel like, oh, I’m failing at my steps even, or whatever. So there’s a gap between what you’re doing.

[00:43:13] Lee: And so there’s a sort of permissive part that can be like, oh, well that doesn’t matter. Don’t bother with that at all. Just give up, don’t try. And, and in a way that is a part who’s trying to give us permission to rest. Um, but it can be quite a negative. So it’s, it is really important to listen to that part because permission to rest, as you’ve said, is, is really key.

[00:43:32] Lee: However, if that part is allowed to kind of run without boundaries, then we can end up sitting on the sofa for really long periods, not achieving things, not getting our process done, running into problems. And actually that then becomes unhelpful in terms of the functionality of our lives and, and, and being the person we want to be.

[00:43:50] Lee: So we need to hear the need for rest without necessarily buying into the idea of, I can’t get anything done at all. Give up. Don’t try. And so it is recognizing that that part really wants to help, wants to protect us from maybe the, the pushing part. There’s another part who’s like, you need to do more, you need to work harder.

[00:44:08] Lee: And what I often see is this kind of flipping between the, you know, when people are doing boom bust, it’s, it’s these two parts showing up. And this is a bit like the, the movie, you know, inside out, if you’ve seen that, where we’ve got the inner, but it, it is not emotions as much as, as parts with a kind of idea about what they want.

[00:44:25] Lee: So we’ve got our inner pusher, like, you need to do more, you need to work harder, you need to be good at this, you need to pass your exams, you need to be a great doctor, you need to be, and, and, and that part is really gr lovely and that’s probably got us through so many different challenges in life. It’s got us through exams. It’s made us a professional, it’s helped us cope under pressure. It’s dealt with really complex patient scenarios, so it is a fantastic part. However, if that part was allowed to run without any checks or boundaries, then that part would run us into the ground. We’d end up exhausted.

[00:44:59] Lee: So we can recognize that that part wants us to do well. We don’t have to be negative about that part at all. We don’t have to shame or blame or criticize the critic. But what we do need to say is, thank you critic, I hear you. I, I really hear that, that you, you want me to do well, and that’s really lovely. Um, I’m just gonna think about who else is here, because the loudest part is often the part that’s most emotionally charged, and so that will be the part we hear the most.

[00:45:26] Lee: Um, and I do a thing called now, which is notice, oh, I’m stressed, observe with my five senses okay, I can see a blue water bottle, um, and a yellow post-it note. I can hear the hum of my computer. Slow sigh. I can hear my breath. I can feel my diaphragm. I can feel my feet. I can move my shoulders. I can relax. I can let go of clenching my jaw. I can make room for stress without trying to eliminate it, but I’m not just dressed. There’s more to me than stress at this moment.

[00:45:57] Lee: And then the W is, okay, well, what is important. Wise mind back to this bigger perspective prefrontal cortex, what’s important for me to focus on? What do I care about? And then I come back and can I do that with my full attention? So it’s kind of mindful activity. It’s doing something that matters, one small step. So it’s a very kind of functional micro mindfulness. So that can be really helpful as well. Um, if you are on the go and you need to crack on with something, but you also need to, so instead of ignore and push through, we use the Now to notice, acknowledge, and then carry on, so it’s.

[00:46:31] Lee: Back to those parts. It’s often about settling, settling ourselves down. And then when we have the space, we almost have like this inner negotiation where we are like, hear from the, the, the, the critic. Well, I know you want, I know you want me to do really well and, and I have my own critic, you know, I have to talk to her all the time ’cause she wants me to do lots of things and can give me a hard time when I’m not doing what she thinks is enough.

[00:46:53] Lee: Um, and then there’s this, oh, well I just give up part. And you’re like, okay, well I know you just want us to be okay. And, and then the anxious part is, I know you want me to be safe and, and I hear all of you. And then my wise mind, which for me is a tree. And I really like the idea of like a wise oak tree, and I see trees a lot, there’s a lot of trees near where I live, and I like to look at them and they’ve been around for hundreds of years and they don’t care about all that stuff that I worry about. They’re just not bothered.

[00:47:19] Lee: So they’re just like waving around in the breeze and, and I can feel like, okay, the tree is strong and they’ve got strong roots and a strong trunk, and they, they’ve lived through rain, snow, and broken branches and they’re still growing and they, and, and so I can sort of align myself with, with that mindset. And then what’s next? It’s like, okay, what’s the next important thing for me to do?

[00:47:41] Rachel: Wow. Lee, there’s so much in there, but I like this idea of parts and is this what you would call internal family systems?

[00:47:47] Lee: Yes, it is definitely based around, yes, it is a version of it, definitely.

[00:47:51] Rachel: And yeah, for me it has been quite helpful, you know, recognizing that what, the critic Okay, thank, thank you, not, not like stop talking, let’s ignore you, let’s put you to the back, I’m gonna ignore you, but thank you, like what are you trying to, what are you trying to help me with there? Like what is your motivation? Okay, thank you. Right, I’ve got it. I hear you. You go sit over there and like, let’s listen to the next one. And that can be really, really helpful.

[00:48:11] Rachel: Do, do people with neurodivergence or neurodivergent traits, do they find it difficult to do that internal family system parts things sometimes, or is it something that everybody finds easy or?

[00:48:23] Lee: I, I think actually lots different people find it. And I wouldn’t necessarily say that that is related to, to neurodivergence. Um, some people are, sometimes it’s just a wiring thing like some people are, oh, yes, I could and really relate to it. And sometimes we give the parts a name, like, we’ll, like, like literally Annie the, the anxious part or, or, or, um, you know, Carl the critic or, you know, sometimes we do that or sometimes we just create a set, you know, so we try and lighten it a bit. I always try to like, make it lighter because I don’t think it helps to make it all doom and gloom.

[00:48:56] Lee: The other thing I’d add about Neurodivergence is that sometimes the parts might vary about what their needs are. So an autistic person might have a part who really likes predictability, for example, and routine, and who gets very distressed if things change unexpectedly, um, and who needs to be soothed.

[00:49:15] Lee: And we can try and support that part by creating as much routine and regularity as possible and try not to lean into the critic who’s like, why do you need this? No one else does. But actually boundary in that part. Okay, yeah, you want us to, to kind of operate, you know, feel like connected to your colleagues, uh, but you are the part who really does need actually routine and, and predictability and that, and so we can just label it as a need, and that part wants predictability.

[00:49:39] Lee: However, if, for example, you go into work and you’ve. You know, there’s been a problem and there’s somebody else working and they’re in, they’ve been put in the room. You normally go in, occasionally that might be inevitable. It might not be possible for that to never happen. And so at that point, we then need to sue that that part might really get affected. And what we don’t need is the critic to be going why are you making such a fuss? This, no one else is upset. But to be like, okay, I get it, this is actually really hard. This is a moment of change. Maybe it’s changing jobs as well can be really challenging, you know, rotating. That can be very difficult for trainees, and more for neuro divergent trainees than than others because of that change element being very distressing.

[00:50:19] Lee: And it’s more about them saying, okay, this will pass this distress. If I pause and ground, they’ll, the, the moment of distress is going to ease. And, and it’s having some strategies that mean that I, i’m not gonna try and fix it while I’m in the tumult of, of distress because that’s when we then are more likely to choose unhelpful strategies that don’t work for us in the longer term.

[00:50:41] Rachel: I have a friend who’s a, she’s the head of SEN at a local sixth form college, and one of her roles is to go around looking at lessons and thinking how can we make this more brain friendly, better for, you know, the kids in the class who do have, you know, dyslexia, autism, ADHD, and some of the other, um, versions of, you know, neurodivergence. And the teachers might push back and say, well, why should I change my entire teaching stuff for one kid? And her response is, this will make it better for everybody.

[00:51:09] Rachel: So I, I think one of the messages we really need to get across about all of this is yes, these, these things will maybe work more for people who are neurodivergent, but they will also work for everybody. And back to my earlier point is that I think a lot of doctors and people who are in these high stress jobs do have particularly, interestingly, different brains anyway. ’cause you sort of need to have different brains to be able to do the job in the first place.

[00:51:35] Lee: Well, what I think is, neuro inclusivity is just something that you can get behind because for all the reasons you’ve said, it supports everybody and it probably does have a greater impact on, on the people at most need. So then that’s a really great thing, isn’t it? Because if it helps everyone, but it differentially helps the people who are struggling the most, then that is a really positive thing. So that would be how I would look at it.

[00:51:58] Lee: It also supports people who perhaps don’t feel comfortable to share their diagnosis in the workplace. And there’s a lot of people like that. I, I work with a lot of people who do not want to tell employers or colleagues because they have a sense of stigma. And I think whilst I’d like to say, oh, I, you know, I, I, I think things are changing, but I think unfortunately there are colleagues who would perceive it quite negatively, and, and actually it isn’t necessarily in everyone’s best interest to share if they feel that it’s an unsafe experience. And people shouldn’t be forced to reveal things about themselves personally unless they feel it’s gonna benefit them personally.

[00:52:34] Lee: So, so, so actually why, when we are thinking about neuro-inclusive workplaces, there may be a good proportion of the, of our workforce who we don’t know is neurodivergent but who may be, and they may not know, they may or may not know themselves, but either way it’s really important to sort of offer that support.

[00:52:50] Lee: And I think the other thing is to come at it from very much a pragmatic, okay, what are my needs approach. Um, and it might be that, you know, if someone has a diagnosis, then they would think about reasonable adjustments, and that’s often done through occupational health and it’s a workplace. But other, there are more informal ways that we can deal with this ourselves that don’t always have to involve making it a very formalized process.

[00:53:14] Lee: Um, and that involves us knowing what kind of needs we might want to be exploring. So, for example, it could be sensory needs. So you might, maybe somebody struggles with really bright or artificial light or if there’s a buzzing and, uh, light bulb. I had someone who had a buzzing light bulb above their desk and it was just made it intolerable to work, they just couldn’t concentrate. Um, so maybe, you know, being able to, the simple things like change the light bulb can make such a difference. Or maybe it smells like air, you know, air fresheners or maybe it’s working from home or having a flexible approach to work where you’re working from home sometimes, or traveling at times that are quite, and that work that crosses over.

[00:53:56] Lee: I mean, there’s the whole thing about, I’ve done a quite a bit of work around the menopause as well and mental health, and I think there’s evidence that, um, new diagnoses in the menopause are, are more likely. And I think because people’s coping strategies are that there’s more pressure, so therefore the masking becomes harder because there’s just more things to manage as well.

[00:54:17] Lee: And also it’s a life stage where there’s a whole lot of stuff going on at the same time. So we’ve got physical symptoms, stressful life experience with children leaving home and, and a change a sense of aging, the whole kind of process. And then our neurodivergent traits. And then it becomes too much. So then the diagnosis sort of appears.

[00:54:35] Lee: Or maybe our child is just being diagnosed that I’ve got a lot of people who say, wow, my, my, you know, my child was diagnosed and actually now I’m looking at them. And I’m, I always thought that was, I thought that was what everyone was like, and now I’m suddenly looking at, I’m like, oh my gosh. I, I’ve, I’m the criteria and I’m like, oh, that was actually me and my whole family, you know.

[00:54:54] Rachel: Yeah.

[00:54:54] Lee: So I think that can be really important. Like the predictability thing for autistic people can be really important. So that might be things like sending out minutes of meetings beforehand, giving an expectation of what’s going to happen. And these can be quite quick, simple things of, you know, we’re gonna have a meeting, we’re gonna talk about this and, and, uh, and would like you to contribute this, is time ready to prepare? Our thinking is not being asked to do things on the on the go.

[00:55:19] Lee: So, so we can look at all of these things, and, and sort of remembering that communication when people are under stress often becomes more difficult. So we might need to just have an allowance and, and a recognition, um, and try and have conversations when people are ready, so that preparation enables people to be less stressed, which means they’ll be able to engage, that prefrontal cortex will be back on. And we need that, you know, when we’re thinking more broadly.

[00:55:45] Lee: So it’s trying to help people to, to thrive rather than thinking about necessarily what’s wrong. It’s like, what would make this, what would help, and what are the strengths? You know, many of these qualities have positive, and it’s the strengths of vulner vulnerabilities side. They’re amazing strengths, and if we get into them too much or we get dominated, then they become a, a, a, a, vulnerable space.

[00:56:11] Rachel: Absolutely. And I mean, I’m very interested in, in what, what the role of the organization is versus the role of the individual. ‘Cause I very much think that the more you can understand yourself and know your particular way the brain works, know what your strengths are, then you can choose the role that you want to be in, what sort of thing you want to do, how you want to work, and then you can ask for what you need in an organization.

[00:56:37] Rachel: I do want to ask you about diagnosis. Uh, we’ve had, we’ve had several people writing into us saying they think they’re probably neurodivergent, they might have ADHD or think they might have autism, but they, there’s a very long waiting list. It’s very costly. They’re not sure the advantages of being diagnosed.

[00:56:56] Rachel: Do they even need to be diagnosed? Can they ask their employees to make adjustments if they’re not diagnosed? So what’s your opinion on the value of diagnosis?

[00:57:04] Lee: So I, I think it’s very much a personal issue and there are different things at place. Um, and I think, so if we start with, with ADHD, then if somebody is thinking about treatment for significant ADHD symptoms with medication, for example, then clearly diagnosis has a important role there, um, where it can facilitate that. Without a diagnosis, that’s not gonna be an option. And then there’s really good evidence that, that it’s, that treatment’s effective and it improves symptoms of ADHD and that can have a big impact on mental health because actually if we’re being triggered by the fact that things are so difficult, it’s difficult to, um, manage our attention and that’s just exhausting to have to keep dealing with that, then that can reduce the risk of burnout significantly.

[00:57:50] Lee: You know, that the diagnostic criteria for ADHD are, are based around what was perceived to be ADHD maybe 20 years ago. So women, for example, are often missed. Um, and it’s really the, the very sort of societal idea about it, it’s often based on boys in a, in a disruptive boys in the classroom.

[00:58:08] Lee: So there’s a whole journey that people go on when they first come to the idea of could, could neurodivergence be something that I would relate to, to, okay, I’m ready to discuss it openly with others. Um, and I don’t think people should be pushed to go down that at any speed quicker than they feel comfortable to do so, or that they do, they may not need to do so. Because if someone’s actually doing quite well at work, um, but they, but they’re, they just need some strategies to manage their own wellbeing and to make choices that honor their needs better, um, then actually that might be enough.

[00:58:39] Rachel: I think it’s, it’s really asking yourself the question, well, what would diagnosis give me? So yes, if I need medication, then obviously if I need to make some requests of work that they won’t look at unless I have a diagnosis, then yes. But actually my diagnosis helped me with obviously medication and things like that.

[00:58:58] Rachel: It helped me just because I could then look and explore myself about ADHD. And there’s so many good podcasts and books out there about all, all the different varieties and, and flavors and, and things like that. And honestly, that’s helped me more than having a diagnosis. You know, I mean, the diagnosis of the kicks off that because I had absolutely no idea I was one of those sort of late diagnosed, menopausal women whose kids are also going through the same thing type thing.

[00:59:24] Rachel: But actually, if you suspect that might be you, even if you don’t have a diagnostic criteria, say for autism or ADHD, then you’ve probably got some traits that you’ve recognized and then the literature and the stuff that’s out there that says, well, this might be helpful. If you have this trait, it’s gonna be helpful for you even if you don’t have an official diagnosis.

[00:59:44] Rachel: And, and any sort of coaching, any good coach will be, and you can get specific, um, neuro divergence coaches, can’t you? But actually, any, any coach or therapist that’s any good will be working with you about your own personal needs anyway, so you’ll be coming up with your own strategy.

[01:00:00] Rachel: So for me, it’s much, much more about self-awareness. For me, diagnosis was helpful because it really helped me understand myself. I had a lot of aha moments going, ah, that’s why, that’s why. But also, it wasn’t enough. I had to do a lot of reading and a lot of listening and a lot of self-awareness stuff.

[01:00:17] Rachel: And of course you have a diagnosis, but no two people are the same anyway. So you still have to go and do that, that self-exploration. Anyway. So I think that that, that answer is, it depends, isn’t it? The, the answer is, should I get a diagnosis is it depends what it’s gonna give you.

[01:00:33] Lee: I a hundred percent agree and you, you know, you think about, uh, what’s always interesting to me is in neurodivergence is a kind of umbrella approach. If you have one form of neurodivergence, you’re, you’re much more likely to have others as well. And so you can really just so that back to that spiky profile, that we may well have strengths and areas of challenge that may span across multiple types of neurodivergence.

[01:00:53] Lee: We may have a diagnosis of ADHD with some autistic traits as well. And so we really need to see ourselves as a unique individual. And it’s definitely not about labeling. Um, and we really need to see, to understand what, what do I need?

[01:01:07] Rachel: Gosh. So Lee, we’ve covered a lot of ground here. Um, if you were to synthesize your three sort of top tips for sort of avoiding burnout on repeat, I think particularly if you are someone who has a diagnosis or think they might be neurodivergence, what would your three top tips be?

[01:01:29] Lee: I think it would be to notice your needs, um, to take some time to proactively pause and notice your parts and your needs. So I have a need for predictability. I have a need for movement. I have a need. And you might notice it by noticing what happens if you don’t get them, that sometimes that’s a really good way to notice like not a positive thing. And, and knowing what they are and try and do it neutrally neutral acceptance. Okay, this is me. It’s, you know, it is what it is. Um, I can be compassionate around that, but I don’t have to do more than that. Just say, okay, okay, this is, this is what we’re dealing with here. And I think that’s really, really important.

[01:02:06] Lee: I would say explore, um, look at some of those resources that you’ve mentioned. Look, there’s so many great, podcasts there. There’s the Neurodivergent Women podcast, for example, which I really rate highly. Um, there’s lots of things about ADHD. There’s about autistic for different groups. So if you are a woman, for example, then looking specifically for resources around women and girls is really, really helpful because it presents quite differently.

[01:02:30] Lee: So I would think find out some information about what things other people might also experience and how they go about it without necessarily feeling like you need to be labeled. You’re not jumping into a label.

[01:02:41] Lee: And then look for these micro ways to meet your needs in, in, in, in a creative way. So, going back to, okay, my need is for movement. Um, not, I must have a walk at 10 o’clock because that’s quite rigid and unhelpful. So looking for flexible ways. Keep it small, keep it micro so you know, anything between one minute and 10 minutes, um, as a doorway to change rather than getting overwhelmed by perfectionist kind of goals. And, and look for micro ways to, so micro fills of the petrol tank. Um, and make sure that the goal is around meeting all the needs, not just the loudest needs.

[01:03:17] Rachel: That’s really helpful And I think I would just add to that, um, moving on from your last point, don’t rely on others. Yeah, work out what’s in your control and take action yourself. You know, you’re not a frog. You can do things yourself. You don’t need to wait for other people. And if you are waiting for other people, you may well be waiting a very long time for other people to notice your needs and then actually act on that.

[01:03:37] Rachel: Um, and we are actually going to be doing a lot more work, um, this autumn winter going into 2026 with a community for neurodivergent doctors or doctors who think differently. So if you’re interested in that, just email hello@youarenotafrog, and just say, interested in ND community or something like that and we will make sure that we, uh, let you know, um, what stuff we’ve got coming out. And also, Lee, you’ve got a podcast coming out, is that right?

[01:04:02] Lee: Yeah, so I’m, I’m gonna be, um, launching a podcast in the autumn called the Choice Space. And it’s all about, um, it’s aimed at everybody. Um, and just looking at ways to, that we can start to bring more choicefulness into our world. And it’s, so it’s going to kind of touch on some of the themes we’ve, we’ve talked about today, how to navigate life, um, in a choiceful way that that enables us and how to get that space in order to make choices that actually meet our needs.

[01:04:32] Rachel: Well Lee, thank you so much for being on here. It is been absolutely fascinating. If we wanna, people wanna find out more about you, where can they go?

[01:04:38] Lee: Yeah, so, um, they can follow me on Instagram, dr.lee.david, um, or I’ve got website, uh, 10minutecbt.co.uk, or follow the Choice Based podcast because we will be launching very soon with lots of episodes.

[01:04:53] Rachel: Brilliant. And uh, yeah, get Lee’s books as well. So we’ll put all those links in the show notes and thank Lee. I’m sure you’ll be coming back again, won’t you? There’s so much more we can talk

[01:05:01] Lee: Oh, definitely. And I’m gonna try and get you to come to me as well, Rachel. I have to be honest.

[01:05:05] Rachel: Definitely, I mean, that’s a, that, that, that the choice space, that is literally what my work is all about. You know, getting the choice and then, and then taking ourselves and not waiting for other people. So, really good conversation. Thank you, and we’ll speak soon.

[01:05:18] Lee: Bye.

[01:05:20] Rachel: Thanks for listening. Don’t forget, you can get extra bonus episodes and audio courses along with unlimited access to our library of videos and CPD workbooks by joining FrogXtra and FrogXtra Gold, our memberships to help busy professionals like you beat burnout and work happier. Find out more at youarenotafrog.com/members.