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Mental Health Pathfinders: Evolving Psychiatry Through a Neurodiverse Lens · The Medical Mind

• 0:04
  Welcome to Mental Health Pathfinders.
• 0:07
  Today we're joined by Dr.
• 0:08
  Bernadette Grosjean, a psychiatrist whose personal journey as an autistic clinician is reshaping how we understand neurodiversity in medicine.
• 0:17
  Her insights challenge long held assumptions and offer a powerful vision for a more inclusive future in psychiatry.
• 0:25
  Thank you so much for joining us for Mental Health Pathfinders.
• 0:29
  Dr.
• 0:29
  Grosjean.
• 0:30
  Well, thank you so much, Irene.
• 0:32
  I'm very excited.
• 0:33
  I think it's an important subject.
• 0:35
  I'm very thankful.
• 0:36
  Absolutely.
• 0:36
  look forward to this discussion so much.
• 0:38
  Now you've shared that recognizing autism in the patient ultimately led to your own diagnosis.
• 0:45
  What was the experience like for you both professionally and personally?
• 0:50
  Yes, indeed.
• 0:52
  So it's a journey that's, I'm 63, right?
• 0:55
  I've been a psychiatrist for a while.
• 0:57
  And the journey kind of started 10 years ago.
• 1:01
  Most of my career, I work with many patients in many settings, but I was very interested in patients with borderline personality disorders.
• 1:09
  And as an expert in quote, in the field, I was referred to patient that people had struggled and she had struggled in the family for decades.
• 1:18
  And, you know, what I knew about
• 1:20
  Autism was the stereotypes.
• 1:22
  We were taught in med school, both here and from Belgium, both here in US where we trained at UCLA and in Belgium where I was trained initially.
• 1:28
  So in general, white boys with multiple intellectual disabilities, the little professor, the Asperger as we said at the time.
• 1:38
  So I didn't know much.
• 1:40
  And thankfully after that patient, I was able to recognize, and I'm thankful for that, that I didn't know as good as an expert as was.
• 1:49
  I didn't know and I needed help.
• 1:51
  And maybe it's the third or four times in my life, I asked for a neuropsychological testing.
• 1:55
  And when these tests came back for someone with a woman in her forties, who had a college education, and I was told, well, of course she's autistic.
• 2:04
  It was a shock.
• 2:06
  It was like questioning a lot of what I'd learned through two trainings, once in Belgium, once here, right?
• 2:12
  It's like, really?
• 2:14
  And that started the journey.
• 2:15
  I need many podcasts to do the details of it.
• 2:18
  But it was, and it reminds me of essentialities for us to recognize when we don't right?
• 2:24
  That we have to be curious, we wanna ask help.
• 2:27
  And sometimes it's hard when we're in a system where everything is so quick, you don't have time to think, you have to know, right?
• 2:33
  So that was a very big lessons.
• 2:35
  And then going of course, learning more, I start to realize that, huh, maybe I'm autistic too, which again was against what I taught.
• 2:48
  But that was, and it was for me, which I've seen time and time again with patients, a relief.
• 2:55
  I'd been in therapy most of my life.
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  I've been in psychoanalysis for 10 years, four times a week.
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  I've learned many type of therapies because I'm curious what works.
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  And suddenly something was there helping to put the puzzle pieces in place.
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  And that was really a big relief.
• 3:13
  And so I realized that and I want to be an advocate.
• 3:18
  And then I decided maybe, you know, I was worried that I would be discredited by my colleagues, like I see my patients.
• 3:24
  Of course, you're not autistic.
• 3:25
  And people would tell me that.
• 3:27
  You're too empathic.
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  You're a doctor.
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  You're a psychiatrist.
• 3:30
  So I got the neuropsychology card testing just after my 59th birthday.
• 3:36
  And it was, if I should say, I passed with flying colors because it's kind of weird, but it was an interesting experience.
• 3:43
  Helped me to understand myself better, not in terms of my own history.
• 3:47
  the history of my family, my father in particular, in terms of my cognition.
• 3:53
  So that was a gift, think, a very good experience, starting by I don't know.
• 4:01
  I'm sure you're not alone in this.
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  mean, how do you think, what do you think, why do you think autism remains under recognized among medical professionals, even in psychiatry?
• 4:13
  Yeah.
• 4:13
  Well, it's very hard because, you know, I'm part of also a group called Autistic Doctor International created by Mary Doherty five years ago.
• 4:25
  are 1200 all over the world.
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  I've learned a lot about that.
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  First, it's good not to be alone, but I learned a lot about the stigma, about the fear, about our old doubts and how for so many realizing
• 4:41
  they were autistic was also going against what they've learned.
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  And that's a big issue, right?
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  Is we're not informed.
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  We've not updated knowledge and know that the knowledge is kind of forced on us.
• 4:54
  In part, thanks to patients, thanks to social media.
• 4:58
  don't see everything is good there, but a lot of things are real or at least open some doors.
• 5:03
  And doctors don't like that, right?
• 5:06
  Nobody like.
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  When you think you're an expert in something that people come and say, yeah, maybe it's something you didn't think about.
• 5:12
  So I think it's a big backlash.
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  Also being part of that group, we realized that the second groups among the specialty, which proportionate the biggest specialty, is psychiatry.
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  So there are actually quite a bit of psychiatrists who are neurodivergent, which say autistic, particularly those, surprise, surprise, working in neurodevelopment.
• 5:36
  right, neurodevelopmental disorder.
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  So first, when he's very close to home, you don't necessarily see that it's a problem.
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  You don't like noisy restaurants to go after work with colleagues.
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  I don't either, right?
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  That's normal, right?
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  So you have this.
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  And then the second part is when you think and you realize maybe there is something there.
• 5:59
  There is so much ableism in medicine and in psychiatry.
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  And autism is, you know, again, the way it's associated with lack of empathy, with psychopathy, with people, blah, blah, blah, all this negative thing, all this disorder and
• 6:15
  deficit.
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  It's hard to identify yourself.
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  You know, I remember my therapist who diagnosed me and say, how does it feel to have a disability?
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  And I was like, disability, you know, speak many languages, my training twice.
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  I didn't identify that, that's really.
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  But once you identify that, yes, a disability because of the environment, because of the way your brain function, it's actually a big relief.
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  But a lot of people, it's hard to recognize.
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  And once they recognize, one of the frequent things is shame.
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  A big, and Mary Doherty did study, she just did a PhD about that.
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  Her paper will be soon in Lancet.
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  Shame is something very powerful for all kinds of reasons.
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  Remember, being autistic, you grow up, you always feel different.
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  deficient, you've not done something right, you don't get what people get spontaneously.
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  So that shame may be a big part, the fear of losing your job, the fear of being kicked out of residency, it happens.
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  I've heard it times and times again, because the residency director thinks of autism like 30 years ago, right?
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  And the tragic tragedy of that is that a lot, paper looked
• 7:30
  at the correlation between shame, non-disclosure, and depression and suicide radiation.
• 7:35
  And clearly, non-disclosure, being scared of that, increases depression, increases risk of suicide, which we know, I worked with a physician support life for two years, we know that
• 7:49
  physicians are very much at risk for suicide.
• 7:53
  You mentioned that being able to connect with patients, others may have found to be a bit more difficult.
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  How do you think your own neurodivergence helps you see or understand things that maybe other clinicians might miss?
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  It was kind of a mystery for me for a very long time, right?
• 8:11
  And I had that again, I did two residency in Belgium and at UCLA.
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  And I often had the reputation, know, send it to Grosjean, she likes those people, you know, the one that nobody else wanna work with.
• 8:25
  And in general, I mean, sometimes it was hard because there are a of emotions, a lot of patients were suicidal, looking back, a lot of patients were probably autistic and were
• 8:34
  misdiagnosed borderline, lots of women.
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  But if you think being autistic means that you have a different way, it's neurological, it's many ways, but some clearly different way than the rest of the population in
• 8:49
  interacting with the world, in understanding the world, in perceiving it, both in terms of sensory perception, but cognition.
• 8:58
  You analyze things differently.
• 9:01
  So I would make the comparison of a first-generation in the US, a first-generation child.
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  was born in the US and his family is coming from another country.
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  And the child often will be the interpreter, will have to learn a new language, learn a new culture, right?
• 9:19
  And it can be impossible or devastating.
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  Or if the child is lucky enough to be smart enough, have some support, you're going to learn that.
• 9:28
  It means that since I have been very young, helped also by the fact that I read a lot.
• 9:36
  start for that 14 philosophy.
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  I try to understand this word that other people seem to get spontaneously and I didn't.
• 9:47
  And I want to understand.
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  So I spend the time and I suppose I'm not the only one trying to make sense, observing, listening, knowing I didn't know spontaneously.
• 9:58
  know, a little bit like the patient at the beginning.
• 10:01
  And I think I've done that.
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  I was interested in psychology very early, it's not by chance, right, and philosophy.
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  And so you acquire that quality that you enrich through books, through movies.
• 10:13
  You're constantly trying to understand the world by necessity.
• 10:17
  It's the way you survive or you get a career or you can evolve in some ways.
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  So I think that this...
• 10:25
  And there's some quality, all autistic people are the same, of course, but they are sometimes being non-judgmental, having curiosity, trying to make connections.
• 10:35
  So all that together, when I would encounter someone who was in difficulty, greet empathy, right?
• 10:40
  You have the stereotype of lack of empathy and it exists.
• 10:44
  And then you have clearly a lot of autistic people who have hyper-empathy.
• 10:47
  When my colleagues were telling me that, it was true, right?
• 10:50
  I cannot watch a violent movie.
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  It's just too hard.
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  I have enough in my life.
• 10:55
  Right?
• 10:55
  So I think looking back that I just want to help them.
• 11:00
  And I didn't have all this belief initially.
• 11:03
  So I was ready to believe them more than maybe other colleagues would.
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  And one of the major lesson, would say major problems I see for so many patients I see now is that the doctor, the psychiatrist did not believe them.
• 11:20
  They did not believe them when they thought maybe they're autistic or that the medication had side effects, even at low dose, right?
• 11:26
  Or that they had some rare autoimmune disease the patient didn't know at the time.
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  But they were very young and they were tired.
• 11:32
  What they encounter again and again and again with autistic patients in the Medicare and psychiatric field is invalidation.
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  And I think a major problem is the doctor don't believe what the patient is telling them.
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  And once they don't believe them and push them away, the patient calls up.
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  There a lot of studies showing how hard it is for an autistic person to make an appointment, to go to the doctor, to be in the waiting room and all that.
• 11:58
  And if we don't believe them, they stop coming.
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  With all other risks, right?
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  An autistic population, dying 10 years, without intellectual disability, dying 10 years younger than others, suicide, the second cause of death.
• 12:13
  In hospital, they are not believed and their death.
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  I mean, it's a life and death situation.
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  They die more than non-autistic people, women in particular, who are not believed.
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  So I come back.
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  I think I believe them, try to work with them.
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  And that is the situation.
• 12:28
  Of course I learn, know, I studied with Kernberg and Linehan and all that.
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  So what do you learn?
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  You learn to validate, to make sure people understand you, to make sure you understand them.
• 12:40
  All that was helpful.
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  And it sounds like you'd like to see the clinician understanding of autism evolve a bit more, especially in how we diagnose and support high functioning or late diagnosed
• 12:54
  individuals as well.
• 12:55
  Yeah.
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  It's complicated really.
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  And, and all these label, right?
• 13:00
  I like to call high masking more than high functioning, right?
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  Because then you're familiar with that.
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  The problem with the labels is low functioning means that we don't try anything while the person may have actually, it may show up later in life resource.
• 13:14
  are a lot of examples of that.
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  And when you think high functioning, so people look normal in court, right?
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  And women in particular men too, but I think we are more tolerant of a man who's going to be a researcher, a special, difficult, doesn't want to be bothered and doesn't go to
• 13:31
  parties with colleagues.
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  It's a lot of social bias, of course, and everything, including medicine and psychiatry.
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  A lot of women will mask.
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  And the problems in general, and that was so problematic, the detection is late, will show up later, sometimes too late.
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  Right?
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  We know menopause makes things worse.
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  We know being in college, know, or this phase of life pregnancy is more difficult for autistic women for all kinds of reasons.
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  And these are times when you can be suicidal.
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  You can be very depressed.
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  Right?
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  And the diagnosis will be often, you know, or depression or borderline because you have problems with emotional regulations.
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  You suddenly, someone who's a professional, works for suddenly has meltdowns, an understandable, we cannot understand the behavior.
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  There's often a history of trauma.
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  So you have all these symptoms.
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  We'll give a label.
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  But if you don't take autism into consideration, a lot of things you're going to do will not be as good as it will be.
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  And some will be counterproductive.
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  Go ahead.
• 14:39
  A basic example is, for instance, the
• 14:42
  One characteristic is hypersensory reality, right?
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  So many autistic, they hear sounds others don't hear, they see things, they're more perceptive.
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  The brain perceives more, so it has its advantages and its disadvantages.
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  So one of the principles of that, and CBT for instance, is you're to get habituated to it.
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  We're going to expose you to it, and then you'll be fine.
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  Well, it doesn't work for an autistic person.
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  The neurology is such that you don't get used to it.
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  It's making you crazy.
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  So when you want to do exposure and socialize someone from the hospital, for instance, and the first thing you do to go out is to go to Costco, it's absolutely counterproductive.
• 15:28
  The person can probably have a meltdown and be back in the hospital.
• 15:31
  So understanding who is behind.
• 15:36
  The same way you said, you know, if I keep speaking English to her, if they're French speaking originally, it's complicated.
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  It's not going to work.
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  Some things may work, but not everything, right?
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  So that's why it's so important to be able to identify.
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  And indeed, we didn't get the tools.
• 15:51
  I mean, it's not that people don't want to know, right?
• 15:54
  Someone.
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  The problem is the people who think they know and don't want to hear anything that changed their convictions and who see the autism uniquely as a deficit.
• 16:04
  I think a lot of colleagues want to know it.
• 16:06
  They don't know where to access that knowledge.
• 16:09
  Yeah, I'd love to hear your message or even your advice that you would offer to autistic trainee or early career psychiatrist.
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  You know, they might be struggling with their own identity in the profession.
• 16:20
  So what advice do you have for them?
• 16:23
  Yeah, of course.
• 16:24
  mean, it is very difficult.
• 16:26
  it's both difficult.
• 16:27
  It's difficult when you don't know why it's so difficult, right?
• 16:29
  Maybe you've been a great student.
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  You are studying at home.
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  You are not exposed to a lot of the stress suddenly come in med school or residency.
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  And you don't know.
• 16:39
  A lot get burned out or depressed.
• 16:41
  Oh, you know, suddenly you have, after a burnout, you have this diagnosis because now we're getting it.
• 16:47
  And that's a big problem.
• 16:48
  We are at the juncture, right?
• 16:50
  Young people have their diagnosis.
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  or the generation doesn't know what it means.
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  They think it means something different than what it is.
• 16:57
  So for a lot of young people, sharing with a residency director in psychiatry, for instance, or in medicine that they're autistic is extremely dangerous.
• 17:06
  And we've seen and I've seen patients being kicked out of residency.
• 17:11
  Now, you may not be autistic and not be a good psychiatrist.
• 17:14
  You may be non-autistic and not a good psychiatrist, right?
• 17:17
  But...
• 17:17
  If you're kicked out of a program because the old belief is you're autistic, you have no empathy, we hired you, we worked with you for two years, or everything went well, but now
• 17:26
  that we know you're autistic, we cannot work for you anymore.
• 17:29
  That's terrible.
• 17:30
  That's unfair.
• 17:32
  That's terrible.
• 17:32
  So one advice is that learn as much about yourself and how to deal with difficult situation in your training.
• 17:41
  Take time off, recognize, don't have shame, recognize your strengths.
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  because there are probably some strengths, your memory, your cognition, your ability to make connection, all that.
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  Be careful.
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  Sometimes one person asks me, what would you tell the younger self knowing what you know?
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  And I say, would tell myself, when someone asks you what you think, don't tell them.
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  Because, I mean, depends on the context, right?
• 18:09
  But because I was so honest, including with my supervisor.
• 18:15
  Or if they ask if it's a problem in the service, in the department, I would say it.
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  Right?
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  That's why so many autistic people are whistleblowers.
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  Right?
• 18:24
  We are asked, we see something that's unfair.
• 18:27
  It's not logical.
• 18:28
  We have a very little kill mind.
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  We share with it.
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  I would tell someone younger, be careful who you're sharing with or not.
• 18:35
  Know that socially, you're not necessarily good at estimating if someone is really honest.
• 18:42
  If someone is, you can trust.
• 18:44
  So many autistic people are victims of trauma and abuse, sexual abuse, you know, because they believe they were naive.
• 18:54
  So you have to be aware that, okay, I'm naive in this society.
• 18:59
  I need to be very careful of the people I work with and look for an environment that can respect, that can foster your qualities because there are many.
• 19:09
  you know, I was taking all these patients that nobody want to work with, right?
• 19:14
  But also make sure that you're not exploited because you so want to please and you're so uncomfortable, maybe embarrassed that you may be different, that you may work to the point
• 19:25
  you're going to burn out and then you cannot finish your residency.
• 19:28
  And I would say, yeah, you know, I don't see it as an illness.
• 19:33
  I know it's all the DSM and all that's going to be FD.
• 19:36
  I'm gay and I'm doing this actually because realizing I was gay 18, a long time ago.
• 19:45
  I was scared of going in psychiatry.
• 19:47
  thought maybe I would not be a good psychiatrist.
• 19:50
  And one of the reasons I was is that some psychiatrists before me at the APA came out and we changed the discourse.
• 19:59
  Now being gay in a society will kill you or exclude you if you create a lot of mental problems and physical too.
• 20:07
  So I see that...
• 20:10
  I don't want to simplify things, but there is really a different form of neurotype with its advantage and disabilities.
• 20:16
  if you have intellectual disabilities and seizure and all that, of course, right?
• 20:22
  Things are changed.
• 20:24
  But we have to, we cannot change it.
• 20:26
  We're not going to be cured.
• 20:27
  The way I think, the way my memory works, you know, we can work around it, but there are things we cannot change.
• 20:35
  So it's the old things.
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  Work with what you have, change what you can.
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  And learn about how to protect yourself and manage yourself, which is a danger.
• 20:46
  When you can work, like a surgeon can work 20 hours, 40 hours in a row.
• 20:51
  Everybody loves that.
• 20:52
  But if you do that for too long, you're going to crash.
• 20:55
  So you have to learn.
• 20:57
  Yeah, a big picture here.
• 20:58
  I mean, you covered a little bit of this, but what would a truly neurodiverse psychiatric workforce look like to you?
• 21:04
  And how do you believe it would change patient care, especially for autistic individuals?
• 21:10
  Yeah.
• 21:10
  So I know it's not very popular right now, but diversity is a fact.
• 21:15
  It's enriching.
• 21:16
  We know, I mean, anybody who works as a lawyer, as a teacher, and of course, as a physician or healthcare providers know that the more we know about others and that we are
• 21:28
  all different and some are more different than others because who they are, their culture, their language, their history and their neurology.
• 21:37
  Right?
• 21:37
  So the more we know about it.
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  The better it is.
• 21:41
  To be able to learn about it, people who are different need to feel comfortable and trust you.
• 21:47
  And they need to know that you're not going to be judged or disqualified or whatever because you're different.
• 21:53
  I'm a woman.
• 21:55
  When I started medicine, women were more numerous than men.
• 21:59
  And I heard that no medicine was not such a glorious profession anymore.
• 22:03
  So it's everywhere.
• 22:05
  And it's we have to overcome time and time again.
• 22:10
  Like I speak about it because I want people to learn, because people have multiple ideas of what autistic can be.
• 22:18
  And I'm one among millions, right?
• 22:20
  If we include that in the force, then people are curious.
• 22:24
  They're less scared to.
• 22:25
  They will ask me by working in a nonprofit, I've been there for 20 years.
• 22:29
  You know, at the beginning, it was a little weird that Dr.
• 22:31
  G was autistic.
• 22:32
  They didn't see me that way, right?
• 22:34
  So I explained, I spoke.
• 22:35
  And you'll be surprised, of course, we work with refugees.
• 22:39
  How many of our refugees and victims of torture are so autistic?
• 22:43
  We autistic kids, they were diagnosed schizophrenic or just PTSD, which is important, but it's not enough.
• 22:49
  So the more we can come out, we integrate, share knowledge.
• 22:55
  That's why I'm doing this interview, right?
• 22:57
  But share knowledge and not to embarrass people who don't know.
• 23:03
  here's a new, it's like we have a new medication.
• 23:05
  We are updated on medication all the time, right?
• 23:08
  This is a new way.
• 23:09
  And to say, if you don't learn to see something different, you're not going to see it.
• 23:13
  But once you've seen it, when you know how to look at it, then it really changed things.
• 23:19
  And I think we need, they are neurodiverse people everywhere in healthcare.
• 23:24
  Some are aware, some are not.
• 23:25
  I work more and more, of course, with people.
• 23:28
  have a lot of patients who are in the system, but then,
• 23:31
  They're not sure if they come on, but the more that will be possible, the more we can welcome more people.
• 23:38
  And we're not good with everybody.
• 23:39
  Nobody is good with everybody.
• 23:42
  But at least we know why we are.
• 23:44
  Maybe we can share why it works.
• 23:48
  Dr.
• 23:49
  Grosjean, thank you so much for sharing your story today.
• 23:52
  We really do appreciate it.
• 23:54
  Thank you so much.
• 23:55
  Thank you.
• 23:57
  And to our listeners, you can find more episodes like this one on a range of mental health topics on APA's Medical Mind Channel.
• 24:05
  It's available on all major podcasting platforms.